Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential

Lovell, N.; Wilcock, A.; Bajwah, S.; Etkind, S.N.; Jolley, C.J.; Maddocks, M.; Higginson, I.J.

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 commentary: Currently, there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease. Mirtazapine is a promising candidate to pursue, with definitive randomised controlled trials required to determine its efficacy and safety in this setting.

Citation

Lovell, N., Wilcock, A., Bajwah, S., Etkind, S., Jolley, C., Maddocks, M., & Higginson, I. (2019). Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential. Expert Review of Respiratory Medicine, 13(2), 173-180. https://doi.org/10.1080/17476348.2019.1563486

• Journal Article Type: Article
• Acceptance Date: Dec 21, 2018
• Online Publication Date: Dec 30, 2018
• Publication Date: 2019
• Deposit Date: Jan 3, 2019
• Publicly Available Date: Dec 31, 2019
• Journal: Expert Review of Respiratory Medicine
• Print ISSN: 1747-6348
• Electronic ISSN: 1747-6356
• Publisher: Taylor & Francis Open
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 2
• Pages: 173-180
• DOI: https://doi.org/10.1080/17476348.2019.1563486
• Keywords: Chronic lung disease, chronic breathlessness, breathlessness perception, mirtazapine, antidepressant
• Public URL: https://nottingham-repository.worktribe.com/output/1442351
• Publisher URL: https://www.tandfonline.com/doi/full/10.1080/17476348.2019.1563486
• Additional Information: Peer Review Statement: The publishing and review policy for this title is described in its Aims & Scope.; Aim & Scope: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=ierx20; Received: 2018-08-24; Accepted: 2018-12-21; Published: 2018-12-30