Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine

Support Care Cancer. 2008 Nov;16(11):1291-8. doi: 10.1007/s00520-008-0425-1. Epub 2008 Feb 26.


Goals of the work: This study aimed 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.

Materials 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.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adaptation, Psychological
  • Adjustment Disorders / drug therapy*
  • Adjustment Disorders / etiology
  • Adrenergic alpha-Antagonists / therapeutic use
  • Adult
  • Antidepressive Agents, Tricyclic / therapeutic use*
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / etiology
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / etiology
  • Female
  • Histamine H1 Antagonists / therapeutic use
  • Humans
  • Imipramine / therapeutic use*
  • Male
  • Mianserin / analogs & derivatives*
  • Mianserin / therapeutic use
  • Middle Aged
  • Mirtazapine
  • Neoplasms / psychology*
  • Pain / drug therapy
  • Pain / etiology
  • Pain / psychology
  • Pain Measurement
  • Psychometrics
  • Self-Assessment
  • Single-Blind Method
  • Sleep / drug effects
  • Sleep Wake Disorders / drug therapy*
  • Sleep Wake Disorders / etiology
  • Stress, Psychological / etiology


  • Adrenergic alpha-Antagonists
  • Antidepressive Agents, Tricyclic
  • Histamine H1 Antagonists
  • Mianserin
  • Mirtazapine
  • Imipramine