0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Mortality Risk of Mirtazapine:  Guilt by Association?

Robert H. Howland, MD1
[+] Author Affiliations
1Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Psychiatry. 2014;71(5):585-586. doi:10.1001/jamapsychiatry.2013.4582.
Text Size: A A A
Published online

Extract

To the Editor In their analysis of psychopharmacology clinical trials data, Khan et al1 found that exposure to heterocyclic antidepressants (imipramine, amitriptyline, maprotiline, and mirtazapine) was associated with an increased mortality risk compared with placebo and with other psychotropic drugs. Although Khan et al1 stated that this finding was seen previously by Cheeta et al,2 the particular study by Cheeta et al observed no deaths associated with mirtazapine or maprotiline. Potential causes of drug-associated mortality include cardiovascular effects and seizures. The wider literature does not support an impression that mirtazapine is associated with significant adverse cardiovascular effects, and mirtazapine is less likely to be associated with seizures compared with maprotiline, imipramine, and amitriptyline.3 Other data have not found that mirtazapine is associated with a risk for death, even following an overdose.4 According to 2011 data from the National Poison Data System in the United States, 2765 human drug exposures resulting in death were documented and 1995 of these fatalities were judged to be related to the drug(s) involved.5 In the National Poison Data System database, deaths were analyzed and sorted according to the substance most likely responsible for the death (referred to as cause rank). Mirtazapine was involved in 22 of the 1995 fatalities (1.1%). The 22 cases all involved multiple drugs. Mirtazapine was judged to have a cause rank of 1 (deemed most likely responsible for the death) in only 1 case (involving alcohol, diazepam, and mirtazapine), although the relative contribution to the fatality was judged to be “probably responsible” rather than “undoubtedly responsible.”5 By lumping mirtazapine together with 3 other pharmacologically dissimilar drugs, the data analysis by Khan et al1 provided a misleading image of the relative mortality risk of mirtazapine. Reporting the mortality risk of mirtazapine alone would be more appropriate.

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();