Background Some previous study has documented the efficacy of 5-HT3 receptors antagonists in the treatment of fibromyalgia.
Objectives The mirtazapine (Remeron), a new generation antidepressive agent, characterised by blocking of 5-HT2 and 5-HT3 receptors and stimulation of 5HT-1 and noradrenergic receptors was used in the treatment of patients with Fibromyalgia syndrome (FS).
Methods Twenty patients (18 female, 2 male), age range 20–64 years, mean 43,58, fulfilling the 1990 ACR criteria for fibromyalgia, entered 6 weeks open study and were given 30 mg mirtazapine per day. Before the administration of the first dose, during the study and at the final visite, the following parameters were measured using the visual analogue scale 0–10 (VAS): pain, morning stiffness (minutes) fatigue, sleep disturbances and other vegetative and functional symptoms. Severity of depression was also evaluated with Hamilton Depression Rating Scale, 17-item version (HDRS).
Results 12 from 17 patients (70%) showed a clinical improvement at the end of the study as a consequence of the reduced intensity of pain (8,1 before, 4,6 after therapy, p < 0,001), morning stiffness (57,6 min.vs 36,8 min., p < 0,005), fatigue (8,3 vs 5,3, p < 0,001), sleep disturbances (8,2 vs 2,5, p < 0,0005), headache (7,1 vs 4,2, p < 0,005), gastrointestinal symptoms (6,1 vs 2,4, p < 0,005) or paresthesia (8,5 vs 4,8, p < 0,005). The reduced severity of depressive symptoms was also observed (17,7 vs 6,8, p < 0,001). Six patients complained of sleepiness and hypotension during the first days of therapy, in three cases dosis of mirtazapine was reduced to 15 mg and treatment continued, three patients (female) were excluded from the study.
Conclusion Our data suggest that mirtazapine could be an effective and promissing method in the treatment of fibromyalgia patients. During the treatment of FS patients strict cooperation beetween rheumatologists and psychiatrist is needed.
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