Use of mirtazapine in patients with chronic breathlessness: a case series

Lovell, Natasha; Bajwah, Sabrina; Maddocks, Matthew; Wilcock, Andrew; Higginson, Irene J.

Abstract

Background: Breathlessness remains a common and distressing symptom in people with advanced disease with few effective
treatment options. Repurposing of existing medicines has been effective in other areas of palliative care, for example, antidepressants
to treat pain, and offers an opportunity to deliver improved symptom control in a timely manner. Previous case series have shown
reduced breathlessness following the use of sertraline (a selective serotonin reuptake inhibitor) in people with chronic obstructive
pulmonary disease.
Cases: Six cases where mirtazapine, a noradrenergic and specific serotonergic antidepressant, was used to treat chronic breathlessness
in advanced lung disease.
Case management: All cases received mirtazapine at a starting dose of 15 mg, prescribed under the care of their primary care
physician. Cases had been receiving mirtazapine for a variable time period (2 weeks to 5 months) at the time of the interviews.
Case outcome: All cases reported less breathlessness and being able to do more. They described feeling more in control of their
breathing, and being able to recover more quickly from episodes of breathlessness. Some cases also reported beneficial effects on
anxiety, panic, appetite and sleep. No adverse effects were reported.
Discussion: Patients with chronic breathlessness in this case series reported benefits during mirtazapine treatment. To determine the
effectiveness of mirtazapine in alleviating breathlessness and improving quality of life in chronic lung disease, blinded randomised
trials are warranted.

Citation

Lovell, N., Bajwah, S., Maddocks, M., Wilcock, A., & Higginson, I. J. (2018). Use of mirtazapine in patients with chronic breathlessness: a case series. Palliative Medicine, doi:10.1177/0269216318787450. ISSN 1477-030X

• Journal Article Type: Article
• Acceptance Date: Jun 20, 2018
• Online Publication Date: Jul 20, 2018
• Publication Date: Jul 20, 2018
• Deposit Date: Sep 10, 2018
• Publicly Available Date: Sep 10, 2018
• Journal: Palliative Medicine
• Electronic ISSN: 1477-030X
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/0269216318787450
• Keywords: Breathlessness, shortness of breath, mirtazapine, antidepressant, case series, advanced disease