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Comparative Effects of Mirtazapine and Fluoxetine on Sleep Physiology Measures in Patients With Major Depression and Insomnia
Abstract
Background Sleep complaints are common in patients with major depressive disorder (MDD). Both MDD and antidepressant drugs characteristically alter objective sleep measures. This study compares the effects of mirtazapine and fluoxetine on sleep continuity measures in DSM-IV MDD patients with insomnia. Method Patients (N = 19) received initial baseline polysomnography evaluations over 2 consecutive nights. Subjects were randomly assigned to either fluoxetine (20-40 mg/day) or mirtazapine (15-45 mg/day) treatment for an 8-week, double-blind, double-dummy treatment trial. Single-night polysomnograms were conducted at weeks 1, 2, and 8, with depression ratings assessed at baseline and weeks 1, 2, 3, 4, 6, and 8. Statistical analysis was performed by repeated-measures analysis of variance followed by Dunnet's post hoc analyses. Results Patients receiving mirtazapine (N = 8) had significant improvement in objective sleep physiology measures at 8 weeks. Improvements in sleep latency, sleep efficiency, and wake after sleep onset were significant after only 2 weeks of mirtazapine treatment. No significant changes in sleep continuity measures were observed in the fluoxetine group (N = 11). Both groups improved clinically in mood and subjective sleep measures from baseline, with no differences between groups. Conclusion These data demonstrate the differential effects of mirtazapine and fluoxetine, with significant improvement in favor of mirtazapine, on objective sleep parameters in MDD…
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“Evidence for their efficacy when used alone is relatively weak 38-42 and no specific agent within this group is recommended as preferable to the others in this group.”
From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [42]
In the citing paper
“However, improvements in sleep latency and total sleep time were not as marked for fluoxetine as they were for mirtazapine, which resulted in more efficient sleep and less nocturnal disturbances than fluoxetine.”
From Antidepressants and their effect on sleep (2005) · cites this paper as Winokur et al., 2003
In the citing paper
“(Winokur et al., 2003) found no differences between fluoxetine (20-40mg) and mirtazapine (15-45mg) in respect of HAMD sleep scores; both showing significant improvements.”
From Antidepressants and their effect on sleep (2005) · cites this paper as Winokur et al., 2003
In the citing paper
“Earlier analyses comparing mirtazapine to other antidepressants, indicated less nocturnal disturbance and better sleep efficiency than with fluoxetine (Winokur et al., 2003) or paroxetine (Ridout et al., 2003), and better HAMD sleep scores than with paroxetine (Schatzberg et al., 2002) or venlafaxine (Guelfi et al., 2001).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Winokur et al., 2003
In the citing paper
“HAMD sleep scores have been shown to be better with mirtazapine than venlafaxine (Guelfi et al., 2001), and similar to fluoxetine (Winokur et al., 2003).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Winokur et al., 2003
In the citing paper
“Clinician-rated HAMDS scores were improved in the trials that investigated citalopram (Mendels et al., 1999), sertraline (Lepine et al., 2000), fluoxetine (Winokur et al., 2003), fluvoxamine (Dalery and Honig, 2003) and paroxetine (Dunbar et al., 1993).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Winokur et al., 2003
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Metadata
- Authors
- Winokur, A., DeMartinis, N. A., McNally, D. P., Gary, E. M., Cormier, J. L., & Gary, K. A.
- Affiliations
- UConn Health (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2003-10-15
- Volume
- 64
- Issue
- 10
- Pages
- 1224-1229
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1984461780
- Cited by
- 165
- References
- 0
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 9 · 2015: 5 · 2014: 5 · 2013: 10 · 2012: 14
- FWCI
- 13.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- mirtazapine, fluoxetine, major depressive disorder, insomnia, sleep continuity, sleep latency, sleep efficiency, wake after sleep onset, antidepressant effects on sleep, polysomnography
- MeSH terms
- Mirtazapine, Adult, Antidepressive Agents, Tricyclic, Major Depressive Disorder, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Female, Fluoxetine, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Male, Mianserin, Middle Aged, Treatment Outcome, Polysomnography, Antidepressive Agents, Second-Generation
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