Influence of mirtazapine on salivary cortisol in depressed patients

In the present study, the impact of mirtazapine treatment on salivary cortisol secretion was investigated in 12 patients (4 men, 8 women) suffering from major depression according to DSM-IV criteria. Patients were treated with mirtazapine for 3 weeks receiving 15mg mirtazapine on day 0; 30mg mirtazapine on day 1; and 45mg mirtazapine per day from day 2 up to the end of the study (day 21). Response to mirtazapine treatment was defined by a reduction of at least 50% in the Hamilton Rating Scale for Depression after 3 weeks of therapy. Salivary cortisol concentrations were measured before treatment (day -1), at the beginning of treatment (day 0), after 1 week (day 7) and after 3 weeks (day 21) of treatment with mirtazapine. Saliva samples were collected hourly from 0800 a.m. up to 0800 p.m. There was a significant reduction of cortisol concentrations already after one day of mirtazapine treatment which was comparable in responders and non-responders. In addition to new pharmacological approaches such as CRH₁ receptor antagonists, mirtazapine therefore appears to be an effective strategy to decrease hypercortisolism and restore HPA system dysregulation in depression.