Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression. An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer Mirtazapine for the treatment of hot flushes in breast cancer survivors: a prospective pilot trial. Hospice experiences and approaches to support and assess family caregivers in managing medications for home hospice patients: A providers survey Beneficial effects of antidepressant mirtazapine in functional dyspepsia patients with weight loss. Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Symptoms and sleep patterns during inpatient treatment of methamphetamine withdrawal: a comparison of mirtazapine and modafinil with treatment as usual. Randomized Pilot Trial of a Telephone Symptom Management Intervention for Symptomatic Lung Cancer Patients and Their Family Caregivers. Efficacy of mirtazapine add on therapy to haloperidol in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled study Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential Psychosocial intervention for war-affected children in Sierra Leone. An Open-Label Long-Term Naturalistic Study of Mirtazapine Treatment for Depression in Cancer Patients Social class and gender patterning of insomnia symptoms and psychiatric distress: a 20-year prospective cohort study Gentle Massage Improves Disease- and Treatment-Related Symptoms in Patients with Acute Myelogenous Leukemia A pilot study to evaluate symptom-oriented selection of antidepressants in patients with cancer. Mirtazapine vs. amitriptyline vs. placebo in the treatment of major depressive disorder. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer A short-term psychoeducational intervention for patients newly diagnosed with cancer Mirtazapine substitution in SSRI-induced sexual dysfunction. The effect of mirtazapine augmentation of clozapine in the treatment of negative symptoms of schizophrenia: a double-blind, placebo-controlled study
AIMS The purpose of the present paper was to evaluate the effectiveness of mirtazapine orally disintegrating tablets for nausea and sleep disturbance , which are common and distressing symptoms of cancer . METHODS This was a 4-week , prospect i ve , open-labeled study of cancer patients . Assessment s were performed at baseline and on days 1 , 3 , 5 , 7 , 14 , and 28 . Primary outcome measures were the Clinical Global Impression scale for nausea/vomiting and the Chonnam National University Hospital-Leeds Sleep Evaluation Question naire ( C-LSEQ ) including total amount of night sleep time . The secondary outcome measures consisted of pain items in the 36-item Short Form Health Survey , the Montgomery-Asberg Depression Rating Scale ( MADRS ) , and the EuroQoL (EQ)-5D .  Forty-two cancer patients were enrolled . RESULTS Those with nausea ( n = 28 ) improved significantly from day 1 . The total night sleep time and each item on the C-LSEQ improved from days 1 - 5 . The scores on the MADRS and the depression/anxiety dimension and visual analog scale of EQ-5D improved significantly from the first week . Pain measures also improved from day 1 . Exacerbation of sleepiness developed in approximately one-third of subjects during the initial few days , but disappeared gradually . CONCLUSION In the present study mirtazapine rapidly improved nausea , sleep disturbance , pain and quality of life , as well as depression in cancer patients .  Mirtazapine may be an effective treatment option in managing cancer patients with multiple distressing symptoms , including nausea and sleep disturbance We performed a pilot open-label , crossover trial of mirtazapine ( 15 and 30 mg at night ) in advanced cancer patients with pain and other distressing symptoms . Twenty patients completed the trial and sixteen dropped out . Following a baseline assessment , patients completed a one-week observation period and were then r and omized to a starting dose of either 15 mg or 30 mg of mirtazapine given at bedtime . After three weeks , subjects were switched to the alternate dose and followed by an additional three-week period , completing the treatment . The average age of the completers was 60.2 years and consisted of 7 women and 13 men . The majority were Caucasian ( n = 18 , 90 % ) and married ( n = 18 , 90 % ) . The drop-out group did not significantly differ from the completers based on age , gender , race , marital status , or tumor type . We examined the impact of mirtazapine therapy on patients ' levels of depression , pain intensity , appetite , insomnia , weight , and overall quality of life . A series of repeated measures ANOVAs were conducted to compare the completers ' status at Weeks 1 , 4 , and 7 compared to baseline and to examine the interaction with starting dose and baseline observations . Scores on the Zung self-rating Depression Scale ( F = 8.20 , P < 0.05 ) and the Functional Assessment of Cancer Therapy - General Measure ( F = 5.73 , P < 0.05 ) were significantly improved at study end ( Week 7 ) and were not dependent on mirtazapine dosage . Patients ' weights were significantly higher at both Week 4 and Week 7 , independent of dosage . Trend level differences were found on Memorial Pain Assessment Card items for pain , pain relief , and mood and on numeric rating scales measuring nausea , anxiety , insomnia , and appetite . This open-label pilot study suggests that mirtazapine may be effective for improving multiple symptoms , depression and quality of life in patients with advanced cancer . A controlled trial of this drug would be valuable Goals of the workThis study aim ed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain , nausea , vomiting , appetite loss , and sleep disturbances  but also depressive and anxiety symptoms .  Material s and methods Fifty-three patients with cancer who were diagnosed with major depressive disorder , anxiety disorder , or adjustment disorder were included . Twenty patients on mirtazapine , 13 patients on imipramine , and 20 patients in the control group without medication were interviewed during three visits ( baseline , third week , and sixth week ) . Pain , nausea , vomiting , appetite loss , and sleep disturbances were evaluated with self- assessment single-symptom scales during each visit . The patients were also asked to complete the Hospital Anxiety Depression Scale ( HADS ) during each visit . Main results There were no significant differences among the three visits in the mirtazapine , imipramine , or control groups in terms of pain , nausea , vomiting , or appetite loss . For the initial , middle , and late insomnia , only the mirtazapine group showed improvements ( p = 0.001 , p = 0.001 , p = 0.003 ) . There were also significant differences in the mean total ( p = 0.03 ) , anxiety ( p = 0.003 ) , and depression ( p = 0.025 ) scores of HADS among the three visits for patients taking mirtazapine . There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients . Conclusion Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients . However , more systematic research , such as placebo-controlled studies , is needed Purpose Individuals with advanced cancer experience substantial distress in response to disease burden and impending mortality . Managing Cancer And Living Meaningfully ( CALM ) is a novel , brief , manualized psychotherapeutic intervention intended to treat and prevent depression and end-of-life distress in patients with advanced cancer . We conducted a r and omized controlled trial to compare CALM with usual care ( UC ) in this population . Methods Patients with advanced cancer were recruited from outpatient oncology clinics at a comprehensive cancer center into an unblinded r and omized controlled trial . Permuted block r and omization stratified by Patient Health Question naire-9 depression score allocated participants to CALM plus UC or to UC alone . Assessment s of depressive symptoms ( primary outcome ) , death-related distress , and other secondary outcomes were conducted at baseline , 3 months ( primary end point ) , and 6 months ( trial end point ) . Analyses were by intention to treat . Analysis of covariance was used to test for outcome differences between groups at follow-up , controlling for baseline . Mixed-model results are reported . Results Participants ( n = 305 ) were recruited between February 3 , 2012 , and March 4 , 2016 , and r and omly assigned to CALM ( n = 151 ) or UC ( n = 154 ) . CALM participants reported less-severe depressive symptoms than UC participants at 3 months ( Δ = 1.09 ; P = .04 ; Cohen ’s d = 0.23 ; 95 % CI , 0.04 to 2.13 ) and at 6 months ( Δ = 1.29 ; P = .02 ; d = 0.29 ; 95 % CI , 0.24 to 2.35 ) . Significant findings for greater end-of-life preparation at 6 months also favored CALM versus UC . No adverse effects were identified . Conclusion Findings suggest that CALM is an effective intervention that provides a systematic approach to alleviating depressive symptoms in patients with advanced cancer and addresses the predictable challenges these patients face The purpose s of the study are to evaluate the efficacy and safety of mirtazapine 30 mg/daily for 12 weeks to reduce hot flushes ( HF )  in women with previous breast cancer and to assess the influence of the same treatment on sleep quality and other menopausal symptoms . A prospect i ve pilot trial was conducted in 40 breast cancer patients with at least seven HF per day . A HF diary was completed daily ; sleep quality and other menopausal symptoms were assessed with the Pittsburgh Sleep Quality Index ( PSQI ) , the Menopause Rating Scale ( MRS ) and the SF-36 Health Survey . Treatment was never started by 13 out of 40 patients ( 32.5 % ) and was interrupted by 7 out of 27 patients ( 25 % ) due to of the occurrence of side effects ( mostly somnolence ) . In the remaining 20 patients who completed the three months treatment period , there was a 55.6 % ( p < 0.05 ) reduction in HF frequency and 61.9 % ( p < 0.05 ) reduction in HF score as compared to baseline . A significant reduction in the MRS score ( 32.8 % ; p < 0.05 ) was observed . Mirtazapine appears to be effective in reducing HF in breast cancer survivors . The more frequent side effect was somnolence . A sizeable compiliance problem has been observed due to the reluctance to take antidepressant drugs and to side effects Background : Hospice providers need to ensure that informal , unpaid caregivers can safely manage medications to alleviate pain and distressing symptoms in patients near the end of life . Aim : This study characterizes hospice providers ’ self-reported experiences and approaches to helping caregivers ’ medication management for home hospice patients . Design : Survey with mixed- method analysis . Setting / Participants : Surveys were administered to a convenience sample of 98 hospice providers ( 74 nurses , 6 physicians , 11 social workers , 7 chaplains ) from 5 Chicago-based agencies in the United States . Results : Among respondents , 67 % rated ensuring proper medication management as “ most important ” in hospice care delivery , and 33 % reported frequently encountering caregivers with problems managing medications . To assess if caregivers had problems managing medications , two categories of approaches emerged from the data : prospect i ve approaches and retrospective warning signs when a problem occurred ( e.g. identifying medication nonadherence after observing a sudden patient health decline ) . Overall , 42 % reported using at least one prospect i ve approach , while 38 % reported only retrospective signs . To help caregivers manage medications , three categories of approaches emerged : teaching to increase knowledge , supporting existing or simplifying medication management process , and counseling to overcome attitudinal barriers . Overall , 6 % reported approaches from all three categories . About 28 % frequently experienced difficulty teaching/supporting caregivers with medication management . As much as 47 % believed that they would benefit “ to a great extent ” from additional re sources to help caregivers . Conclusions : Supporting caregivers in medication management is considered important , yet challenging , to hospice providers . Additional re sources may be needed to help providers consistently and effectively teach , support , and assess caregivers ’ medication management AIM To explore the effects and mechanism of action of antidepressant mirtazapine in functional dyspepsia ( FD ) patients with weight loss . METHODS Sixty depressive FD patients with weight loss were r and omly divided into a mirtazapine group ( MG ) , a paroxetine group ( PG ) or a conventional therapy group ( CG ) for an 8-wk clinical trial . Adverse effects and treatment response were recorded . The Nepean Dyspepsia Index-symptom ( NDSI ) checklist and the 17-item Hamilton Rating Scale of Depression ( HAMD-17 ) were used to evaluate dyspepsia and depressive symptoms , respectively . The body composition analyzer was used to measure body weight and fat . Serum hormone levels were measured by ELISA . RESULTS ( 1 ) After 2 wk of treatment , NDSI scores were significantly lower for the MG than for the PG and CG ; ( 2 ) After 4 or 8 wk of treatment , HAMD-17 scores were significantly lower for the MG and PG than for the CG ; ( 3 ) After 8 wk of treatment , patients in the MG experienced a weight gain of 3.58 ± 1.57 kg , which was significantly higher than that observed for patients in the PG and CG . Body fat increased by 2.77 ± 0.14 kg , the body fat ratio rose by 4 % , and the visceral fat area increased by 7.56 ± 2.25 cm(2 ) ; and ( 4 ) For the MG , serum hormone levels of ghrelin , neuropeptide Y ( NPY ) , motilin ( MTL ) and gastrin ( GAS ) were significantly upregulated ; in contrast , those of leptin , 5-hydroxytryptamine ( 5-HT ) and cholecystokinin ( CCK ) were significantly downregulated . CONCLUSION Mirtazapine not only alleviates symptoms associated with dyspepsia and depression linked to FD in patients with weight loss but also significantly increases body weight ( mainly the visceral fat in body fat ) . The likely mechanism of mirtazapine action is regulation of brain-gut or gastrointestinal hormone levels PURPOSE / OBJECTIVES To examine the sources of uncertainty in older African American and Caucasian long-term breast cancer survivors by focusing on frequency of triggers of uncertainty about cancer recurrence and physical symptoms linked to long-term treatment side effects . DESIGN In the context of a larger r and omized , controlled treatment- outcome study , data were gathered from 10 monthly follow-up telephone calls by nurses . SETTING Rural and urban regions of North Carolina . SAMPLE 244 older women ( mean age = 64 years ) ; 73 African American women and 171 Caucasian women who were five to nine years after breast cancer diagnosis . FINDINGS The most frequent triggers were hearing about someone else 's cancer and new aches and pains . The most frequent symptoms were fatigue , joint stiffness , and pain . Although no ethnic differences occurred in the experience of symptoms , Caucasian women were more likely than African American women to report that their fears of recurrence were triggered by hearing about someone else 's cancer , environmental triggers , and information or controversy about breast cancer discussed in the media . CONCLUSIONS Illness uncertainty persisted long after cancer diagnosis and treatment , with most women experiencing multiple triggers of uncertainty about recurrence and a range of symptoms and treatment side effects . IMPLICATION S FOR NURSING Nurses can help cancer survivors to identify , monitor , and manage illness uncertainty and emotional distress The safety and tolerability of modafinil  ( 400 mg/day , n = 14 ) and  mirtazapine  ( 60 mg/day , n = 13 ) in inpatient methamphetamine withdrawal treatment were compared to a historical comparison group receiving treatment as usual ( pericyazine , 2.5 - 10 mg/day , n = 22 ) . Modafinil and mirtazapine were well tolerated , producing minimal positive subjective effects and no discontinuation effects in this open-label study . Side effects were mild and transient . Aches and pains were most commonly reported by participants receiving mirtazapine , whereas headache was reported by modafinil-treated participants . Modafinil-treated participants had a milder withdrawal syndrome as measured by the Amphetamine Cessation Symptom Assessment and less sleep disturbance in comparison to mirtazapine . Pericyazine was associated with a more severe withdrawal syndrome in comparison to mirtazapine and modafinil . Both modafinil and mirtazapine were safe and well tolerated in methamphetamine withdrawal treatment . However , these early findings of efficacy in symptom amelioration should be replicated in an adequately powered , r and omized , placebo-controlled double-blind design CONTEXT Lung cancer is one of the most common cancers affecting both men and women and is associated with high symptom burden and psychological distress .  Lung cancer patients ' family caregivers also show high rates of distress . However , few interventions have been tested to alleviate significant problems of this population . OBJECTIVES This study examined the preliminary efficacy of telephone-based symptom management ( TSM ) for symptomatic lung cancer patients and their family caregivers . METHODS Symptomatic lung cancer patients and caregivers ( n = 106 dyads ) were r and omly assigned to four sessions of TSM consisting of cognitive-behavioral and emotion-focused therapy or an education/support condition . Patients completed measures of physical and psychological symptoms , self-efficacy for managing symptoms , and perceived social constraints from the caregiver ; caregivers completed measures of psychological symptoms , self-efficacy for helping the patient manage symptoms and managing their own emotions , perceived social constraints from the patient , and caregiving burden . RESULTS No significant group differences were found for all patient outcomes and caregiver self-efficacy for helping the patient manage symptoms and caregiving burden at two- and six-weeks post-intervention . Small effects in favor of TSM were found regarding caregiver self-efficacy for managing their own emotions and perceived social constraints from the patient . Study outcomes did not significantly change over time in either group . CONCLUSION Findings suggest that our brief telephone-based psychosocial intervention is not efficacious for symptomatic lung cancer patients and their family caregivers . Next steps include examining specific intervention components in relation to study outcomes , mechanisms of change , and differing intervention doses and modalities The negative symptoms of  schizophrenia  remain a major clinical challenge . Mirtazapine is an antidepressant with antagonist properties at 5-HT2A , 5-HT3 and alpha 2 receptors as well as indirect 5-HT1a agonist effects . Many of these pharmacological actions have clinical or pre clinical evidence of efficacy in schizophrenia . This study was a 6-week r and omized placebo-controlled trial of mirtzepine or placebo add on to haloperidol 5 mg in the treatment of 30 patients with DSM-IV schizophrenia . The primary finding of the trial was a 42 % reduction in Positive and Negative Syndrome Scale ( PANSS ) negative symptom scores in the mirtazapine group compared to placebo at the end of 6 weeks ( mirtazapine 13.9 , SD 1.56 ; placebo 23.9 , SD 1.56 ; P = 0.000 , F = 20.31 , d.f . = 1 ) . The PANNS total scores , Clinical Global Impression severity and improvement scales in addition showed superiority of mirtazapine over placebo . There was no difference between the groups on the Hamilton depression scale at endpoint , suggesting that the improvement in negative symptoms was not an artifact of mood improvement . These results suggest a potential role for mirtazapine in the negative symptoms of schizophrenia PURPOSE / OBJECTIVES To describe women 's unexpected and distressing symptom experiences after breast cancer treatment . RESEARCH APPROACH Qualitative and descriptive . SETTING Depending upon their preference , participants were interviewed in their homes or in a private office space in a nearby library . PARTICIPANTS Purposive sample of 13 women 1 - 18 years after breast cancer treatment . METHOD OLOGIC APPROACH Secondary analysis of phenomenologic data ( constant comparative method ) . MAIN RESEARCH VARIABLES Breast cancer symptom distress , ongoing symptoms , and unexpected experiences . FINDINGS Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment . Symptoms included pain , loss of energy , impaired limb movement , cognitive disturbance , changed sexual experience , and lymphedema . Four central themes were derived : living with lingering symptoms , confronting unexpected situations , losing precancer being , and feeling like a has-been . Distress intensified when women expected symptoms to disappear but symptoms persisted instead . Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a has been . Findings suggest that symptom distress has temporal , situational , and attributive dimensions . CONCLUSIONS Breast cancer survivors ' perceptions of ongoing and unexpected symptoms have important influences on quality of life . Underst and ing temporal , situational , and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment . INTERPRETATION Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur . Prospect i ve studies are needed to examine symptom distress in terms of temporal , situational , and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment ABSTRACT Introduction :  Chronic breathlessness  is a common and distressing symptom of advanced disease with few effective treatments . Central nervous system mechanisms are important in respiratory sensation and control . Consequently , drugs which may modify processing and perception of afferent information in the brain may have a role . Antidepressants have been proposed ; however , current evidence is limited . Of potentially suitable antidepressants , mirtazapine is an attractive option given its tolerability profile , low cost , and wide availability , along with additional potential benefits . Areas covered : The paper provides an overview of the physiology of breathlessness , with an emphasis on central mechanisms , particularly the role of fear circuits and the associated neurotransmitters . It provides a potential rationale for how mirtazapine may improve chronic breathlessness and quality of life in patients with advanced disease . The evidence was identified by a literature search performed in PubMed through to October 2018 . Expert opinion : Currently , there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease . Mirtazapine is a promising c and i date to pursue , with definitive r and omized controlled trials required to determine its efficacy and safety in this setting BACKGROUND There are no psychosocial interventions to address both educational needs and psychological distress among displaced children in post-conflict setting s. AIMS To assess the psychosocial status of displaced children enrolled in the Rapid-Ed intervention ;  and to determine whether the Rapid-Ed intervention alleviated traumatic stress symptoms that interfere with learning among war-affected children in Sierra Leone . METHOD A r and omly selected sample of 315 children aged 8 - 18 years who were displaced by war were interviewed about their war experiences and reactions to the violence before and after participating in the 4-week Rapid-Ed intervention combining basic education with trauma healing activities . RESULTS High levels of intrusion , arousal and avoidance symptoms were reported at the pre-test interviews conducted 9 - 12 months after the war . Post-test findings showed statistically significant decreases in intrusion and arousal symptoms ( P<0.0001 ) , a slight increase in avoidance reactions ( P<0.0001 ) and greater optimism about the future . CONCLUSIONS The findings suggest potential for combining basic education with trauma healing activities for children in post-conflict setting s , but confirmatory studies using a control group are needed . Conducting research in post-conflict setting s presents unique challenges Abstract Background : Depression is quite common among cancer patients . It has yet to be determined which antidepressant is the most effective in cancer patients with depression . Methods : The present study included 21 consecutive depressed oncology patients of whom 19 were followed up for 6 months . All patients initially received mirtazapine 15 mg/day and the dose was increased in the absence of significant treatment response and adverse effects . Results : Depressive symptoms diminished at the end of month 1 and this improvement was maintained for the remaining 23 weeks of the study . Mean 17-item Hamilton Rating Scale for Depression ( HAM-D-17 ) scores fell significantly from 21.4 ± 4.9 at baseline to 6.5 ± 3.2 at the end of the first month of treatment ( p < 0.001 ) . Among the 19 patients who were followed up , five reported at least one adverse effect during treatment ; however , the vast majority of these adverse effects were described as mild to moderate . Conclusion : This prospect i ve , open-label study provides preliminary evidence regarding the efficacy , safety and tolerability  of mirtazapine treatment in cancer patients with depression . Relatively low doses of mirtazapine appeared to be safe and effective for treating cancer patients undergoing radiotherapy and /or chemotherapy , and the reduction in the severity of depressive symptoms was maintained until the end of the 24-week treatment period Background Psychiatric distress and insomnia symptoms exhibit similar patterning by gender and socioeconomic position . Prospect i ve evidence indicates a bi-directional relationship between psychiatric distress and insomnia symptoms so similarities in social patterning may not be coincidental . Treatment for insomnia can also improve distress outcomes . We investigate the extent to which the prospect i ve patterning of distress over 20 years is associated with insomnia symptoms over that period . Methods 999 respondents to the Twenty-07 Study had been followed for 20 years from approximately ages 36–57 ( 73.2 % of the living baseline sample ) .  Psychiatric distress  was measured using the GHQ-12 at baseline and at 20-year follow-up . Gender and social class were ascertained at baseline . Insomnia symptoms were self-reported approximately every five years . Latent class analysis was used to classify patterns of insomnia symptoms over the 20 years . Structural Equation Models were used to assess how much of the social patterning of distress was associated with insomnia symptoms . Missing data was addressed with a combination of multiple-imputation and weighting . Results Patterns of insomnia symptoms over 20 years were classified as either healthy , episodic , developing or chronic . Respondents from a manual social class were more likely to experience episodic , developing or chronic patterns than those from non-manual occupations but this was mostly explained by baseline psychiatric distress . People in manual occupations experiencing psychiatric distress however were particularly likely to experience chronic patterns of insomnia symptoms . Women were more likely to experience a developing pattern than men , independent of baseline distress . Psychiatric distress was more persistent over the 20 years for those in manual social classes and this effect disappeared when adjusting for insomnia symptoms . Irrespective of baseline symptoms , women , and especially those in a manual social class , were more likely than men to experience distress at age 57 . This overall association for gender , but not the interaction with social class , was explained after adjusting for insomnia symptoms . Sensitivity analyses supported these findings . Conclusions Gender and socioeconomic inequalities in psychiatric distress are strongly associated with inequalities in insomnia symptoms . Treatment of insomnia or measures to promote healthier sleeping may therefore help alleviate inequalities in psychiatric distress Objective Cancer treatment is reported to be stressful , and patients diagnosed with hematologic cancers often exhibit higher levels of anxiety and emotional distress than individuals with other malignancies . Management of these symptoms in patients with hematologic cancer presents significant challenges , as many of them are in and out of the hospital while undergoing high dose chemotherapy . Oncology patients use complementary modalities such as therapeutic massage in an attempt to alleviate disease and treatment-related symptoms , including anxiety and emotional distress . In the current study , the feasibility of a novel massage intervention delivered over the continuum of care , as well as assessment of the immediate and cumulative effects of massage , was examined in patients with acute myelogenous leukemia . Methods A mixed- methods , unmasked , prospect i ve , r and omized study was conducted with two groups : a usual care alone control group and a massage therapy intervention plus usual care group . Results Significant improvements in levels of stress and health-related quality of life were observed in the massage therapy group versus the usual care alone group , after adjusting for anxiety level , including both immediate and cumulative effects of massage . Conclusions While the findings of the current study regarding acceptability , feasibility , and potential efficacy of therapeutic massage as a complementary health-enhancing intervention in patients diagnosed with acute myelogenous leukemia are very promising , the relatively small size of the study sample limits generalizability BACKGROUND Major depressive disorder ( MDD ) is a common and debilitating illness in patients with cancer . However , the optimal treatment of depression in these patients remains uncertain , with limited evidence to support the use of pharmacologic therapy . We conducted a pilot study to evaluate the feasibility of an antidepressant clinical trial in the oncology population and the process of symptom-oriented selection of antidepressants ( citalopram or mirtazapine ) in patients with cancer and MDD . METHODS This was a single center , two-arm , nonr and omized , open-label , nine-week pilot study of mirtazapine or citalopram in cancer patients with MDD . The primary endpoint was the feasibility to recruit and to retain patients . Secondary outcomes included changes in Patient Health Question naire-9 ( PHQ-9 ) ( depression ) , Functional Assessment of Cancer Therapy-General ( FACT-G ) ( quality of life ) , Functional Assessment of Chronic Illness Therapy-Fatigue ( FACIT-Fatigue ) ( fatigue ) , and Pittsburgh Sleep Quality Index ( PSQI ) ( sleep ) . We conducted descriptive statistics and responder analyses . RESULTS Of 21 patients , 18 ( 86 % ) successfully completed the study . An average of 2.8 subjects were enrolled per month . Mean scores on the PHQ-9 improved overall by 6.4 points ( 95 % confidence interval [ CI ] 3.6 - 9.2 ) . Additionally , mean FACT-G , FACIT-Fatigue , and PSQI scores improved in both study arms . CONCLUSION Conducting antidepressant clinical trials is challenging in the oncology population . We approached but did not meet our feasibility goals . Depression and quality of life ( QOL ) scores improved with both mirtazapine and citalopram , but evidence -based pharmacologic treatments for depression in cancer patients are needed Patients ( n = 150 ) were r and omized to a 6-week , double-blind study to evaluate the relative efficacy and safety of mirtazapine , amitriptyline , and placebo in the treatment of major depressive disorder symptoms . Average daily modal doses were mirtazapine , 18 mg ; amitriptyline , 111 mg ; and placebo , 4.6 capsules . Mirtazapine- and amitriptyline-treated patients had statistically significantly greater mean Hamilton Rating Scale for Depression ( HAM-D ) score reductions ( weekly visits 1 , 2 , 4 , and endpoint ) compared to placebo . These findings were supported by the Montgomery-Asberg Depression Rating Scale ( MADRS ) ; the Zung Self-rating Depression Scale ( SDS ) ; and the Clinical Global Impressions ( CGI ) scales . Somnolence and weight gain were the only adverse clinical experiences ( ACEs ) reported substantially more often by mirtazapine-treated patients than by those in the placebo group . However , more amitriptyline-treated patients reported decreased visual accommodation , dry mouth , dyspepsia , constipation , tachycardia , hypertension , hypotension , discoordination , dizziness , and tremor than mirtazapine- or placebo-treated patients . Results of this study indicate that mirtazapine is more effective than placebo in the treatment of these patients , and superior to amitriptyline in respect to anticholinergic and cardiovascular effects Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses . The primary purpose of this r and omized controlled trial was to determine the efficacy of a mindfulness‐based stress reduction ( MBSR ) intervention for mood disorders in women with breast cancer . Secondary outcomes were symptom experience , health status , coping capacity , mindfulness , posttraumatic growth , and immune status . This RTC assigned 166 women with breast cancer to one of three groups :  MBSR ( 8 weekly group sessions of MBSR ) , active controls ( self‐instructing MBSR ) and non‐MBSR . The primary outcome measure was the Hospital Anxiety and Depression Scale . Secondary outcome measures were : Memorial Symptom Assessment Scale , SF‐36 , Sense of Coherence , Five Facets of Mindfulness Question naire , and Posttraumatic Growth Index . Blood sample s were analyzed using flow cytometry for NK‐cell activity ( FANKIA ) and lymphocyte phenotyping ; concentrations of cytokines were determined in sera using commercial high sensitivity IL‐6 and IL‐8 ELISA ( enzyme‐linked immunosorbent assay ) kits . Results provide evidence for beneficial effects of MBSR on psychological and biological responses . Women in the MBSR group experienced significant improvements in depression scores , with a mean pre‐MBSR HAD‐score of 4.3 and post‐MBSR score of 3.3 ( P = 0.001 ) , and compared to non‐MBSR ( P = 0.015 ) . Significant improvements on scores for distress , symptom burden , and mental health were also observed . Furthermore , MBSR  facilitated coping capacity as well as mindfulness and posttraumatic growth . Significant benefits in immune response within the MBSR group and between groups were observed . MBSR have potential for alleviating depression , symptom experience , and for enhancing coping capacity , mindfulness and posttraumatic growth , which may improve breast cancer survivorship . MBSR also led to beneficial effect on immune function ; the clinical implication s of this finding merit further research The psychological and medical problems encountered by cancer patients are numerous and unique . The diagnosis of cancer frequently produces psychological distress . A review of the literature and the authors ' clinical and research experience suggest that cancer patients may benefit from a variety of psychological intervention programs . A structured , psychiatric intervention consisting of health education , stress management/behavioral training , coping ( including problem-solving techniques ) , and psychosocial group support offers the greatest potential benefit for patients newly diagnosed or in the early stages of their treatment . Early-stage interventions that encourage active behavioral coping and active cognitive coping rather than avoidance or passive acceptance of the illness can be helpful psychologically . These active behavioral and cognitive coping behaviors , which can be learned , can attenuate the psychological distress caused by stressful illness , decrease the amount of psychosocial adjustment to the illness needed , improve overall quality of life , and may also be associated with longer survical times BACKGROUND Sexual side effects are a common and bothersome reaction to selective serotonin reuptake inhibitors ( SSRIs ) , frequently leading to cessation of treatment . Mirtazapine , an alpha2-adrenoceptor and serotonin-2/3 receptor antagonist , appears to cause few sexual problems . METHOD Nineteen patients ( 12 women and 7 men ) , with SSRI-induced sexual dysfunction who were in remission from major depressive disorder ( total Hamilton Rating Scale for Depression [ HAM-D ] score < or = 10 ) , were switched to open-label mirtazapine for up to 6 weeks . Mirtazapine was titrated from 7.5 mg to 45 mg daily , as tolerated . Sexual functioning was measured weekly with the Arizona Sexual Experiences Scale ( ASEX ) , and depression was measured weekly with the HAM-D. RESULTS Eleven patients ( 58 % ) had a return of normal sexual functioning ( mean + /- SD ASEX score = 12+/-3 ) , and another 2 ( 11 % ) reported significant improvement in sexual functioning ( mean ASEX score reduced from 24+/-1 to 20+/-0 ) . All nineteen patients maintained their antidepressant response ( HAM-D score after 6 weeks of mirtazapine = 6+/-3 ) . The most commonly reported side effects ( using moderate/severe rating on a symptom checklist ) were initial sedation ( N = 3 ) , irritability ( N = 6 ) , and muscle soreness and stiffness ( N = 3 ) . Weight gain of 10 to 20 lb ( 4.5 - 9 kg ) was seen in 3 patients ( 2 women and 1 man ) . CONCLUSION Mirtazapine is an effective antidepressant for many patients experiencing SSRI-induced sexual dysfunction The development of therapeutic strategies to effectively treat negative symptoms remains one of the primary goals in the treatment of schizophrenia .  Mirtazapine is the first of a new class of dual action compounds , the noradrenergic and specific serotonergic antidepressants ( NaSSa ) , whose activity is related to the enhancement of noradrenergic and serotonergic transmission by a presynaptic & agr;2 antagonism and postsynaptic 5-HT2 and 5-HT3 antagonism , respectively . This study was a 8-week double-blind , r and omized , placebo-controlled trial of 30 mg adjunctive mirtazapine to clozapine therapy in 24 patients with DSM-IV schizophrenia . The main finding at the end of the trial was a significant reduction on the Scale for the Assessment of Negative Symptoms ( SANS ) total scores in the mirtazapine group compared to placebo ( P<0.01 ) with a significant improvement on the SANS subscales avolition/apathy and anhedonia/asociality . The Brief Psychiatric Rating Scale total score at week 8 showed superiority of mirtazapine over placebo . These findings suggest a potential role for mirtazapine as an augmentation strategy in the treatment of negative symptoms of schizophrenia
However , mirtazapine showed effectiveness in treating depression , anxiety , sleep disorders , emesis and neuropathic pain .
Across all studies , mirtazapine is safe to use , with drowsiness and dizziness the most common side-effects .
Cancer patients often experience multiple distressing symptoms which are challenging to manage .
It would therefore be helpful to find a treatment that alleviates more than one symptom , to avoid polypharmacy : mirtazapine has been used in several studies for this purpose .
The objective of this study was to assess the effectiveness and safety of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms .