More evidence on proneurocognitive effects of add-on mirtazapine in schizophrenia

• Published in: Progress in neuro-psychopharmacology & biological psychiatry 2011-06, Vol.35 (4), p.1080-1086
• Main Authors: Stenberg, Jan-Henry, Terevnikov, Viatcheslav, Joffe, Marina, Tiihonen, Jari, Tchoukhine, Evgueni, Burkin, Mark, Joffe, Grigori
• Format: Article
• Language: English
• Subjects: Adult; Antidepressive Agents, Tricyclic - therapeutic use; Antipsychotic Agents - therapeutic use; Cognition - drug effects; Cross-Sectional Studies; Double-Blind Method; Drug Therapy, Combination; Executive Function - drug effects; Female; Humans; Male; Memory - drug effects; Mianserin - analogs & derivatives; Mianserin - therapeutic use; Mirtazapine; Neurocognition; Neuropsychological Tests; Psychomotor Performance - drug effects; Schizophrenia; Schizophrenia - drug therapy; Schizophrenic Psychology; Stroop Test; Trail Making Test; Verbal Behavior; Visual Perception - drug effects; Wechsler Scales
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2011.03.004

Enhancement of neurocognition is essential in the treatment of schizophrenia. In our previously reported six-week Randomized Controlled Trial (RCT) mirtazapine added to conventional antipsychotics improved not only negative, but also positive symptoms and neurocognition in difficult-to-treat schizophrenia. The present study aimed to explore whether a prolonged exposure to mirtazapine could further improve neurocognition. Completers of the RCT who were able and willing to proceed to the extension phase received open label mirtazapine for an additional 6 weeks. During the extension phase, both groups (i.e., patients who previously received mirtazapine and those who received placebo) and the whole population showed improvement on a number of neurocognitive tests. Patients who shifted to open label mirtazapine from placebo achieved in the six following weeks similar results as their initially mirtazapine-treated counterparts did during their first 6 weeks of mirtazapine exposure. Middle-term mirtazapine treatment (12 weeks) demonstrated an advantage over short-term mirtazapine treatment (6 weeks) on Stroop Dots time and Trail Making Test, part B, number of mistakes (t = − 2.562, p = 0.035 and t = − 2.42, p = 0.043, correspondingly). Mirtazapine added to antipsychotics consistently shows desirable effects on neurocognition. Lengthy treatment seems worthwhile. Mirtazapine may become a safe and cost-saving neurocognitive enhancer in schizophrenia, yet more studies are needed. ► Enhancement of neurocognition is essential in the treatment of schizophrenia. ► Mirtazapine added to antipsychotics shows some desired effects on neurocognition. ► Cognitive benefits of mirtazapine may affect mostly attention and executive functions. ► Prolonged treatment with adjunctive mirtazapine may yield additional benefits.