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Pharmacopsychiatry 2013; 46(02): 59-62
DOI: 10.1055/s-0032-1323655
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Effects of Mirtazapine on the Sleep Wake Rhythm of Geriatric Patients with Major Depression: An Exploratory Study with Actigraphy

B. Rothschild-Fuentes
1   Servicio de Psicogeriatría, Hospital Psiquiátrico Fray Bernardino Alvarez, México, D.F., México
,
A. Roche
1   Servicio de Psicogeriatría, Hospital Psiquiátrico Fray Bernardino Alvarez, México, D.F., México
,
A. Jiménez-Genchi
2   Clínica del Sueño, INPRF
,
J. C. Sánchez-Ferrer
3   Grupo de Cronoecología y Etología Humana, INPRF
,
A. Fresan
4   Lab. Epidemiologia Clinica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México, D.F., México (INPRF)
,
J. Muñoz-Delgado
3   Grupo de Cronoecología y Etología Humana, INPRF
5   Facultad de Psicología, UNAM, México, D.F., México
› Author Affiliations
Further Information

Publication History

received 28 March 2012
revised 05 July 2012

accepted 15 July 2012

Publication Date:
22 August 2012 (online)

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Abstract

Introduction:

Major depression and insomnia are among the most frequent neuropsychiatric syndromes in the geriatric population. Although most SSRI antidepressants affect sleep continuity, mirtazapine has been found to improve sleep continuity in patients with depression. The aim of the present study was to assess by actigraphic recordings changes in sleep patterns of geriatric patients with major depression before and during treatment with mirtazapine (30 mg).

Methods:

Patients aged 60 years or more with major depressive disorder were recruited at the outpatient service of a specialized mental health centre. Severity of depression was rated with the Montgomery-Asberg depression rating scale and subjective perception of sleep was assessed with the Pittsburgh sleep quality index (PSQI). Actigraphic parameters were registered 4 days before the onset of mirtazapine treatment (patients were drug free in this period of time) and recorded at day 60 of treatment with mirtazapine.

Results:

A significant decrease was observed in the sleep fragmentation index. While a significant improvement was observed in the subjective assessment of quality after treatment with mirtazapine, actigraphic measures of sleep parameters did not show changes in line with mirtazapine treatment.

Discussion:

Mirtazapine produces minimal changes on actigraphic measures in the sleep of elderly outpatients. Sleep produced by mirtazapine indicates a more pronounced effect in ≥ 80-year-old patients. This differential response should be considered during treatment of this clinical population.

Key words

sleep disturbances - sleep deprivation - depression - depression treatment
 

  • References

  • 1 Buysse DJ. Insomnia, depression and aging. Assessing sleep and mood interactions in older adults. Geriatrics 2004; 59: 47-51
    PubMedGoogle Scholar
  • 2 Kupfer DJ, Reynolds CF, Ulrich RF et al. EEG sleep, depression, and aging. Neurobiol Aging 1982; 3: 351-360
    CrossrefPubMedGoogle Scholar
  • 3 Knowles JB, MacLean AW. Age-related changes in sleep in depressed and healthy subjects. A meta-analysis. Neuropsychopharmacology 1990; 3: 251-259
    PubMedGoogle Scholar
  • 4 Livingston G, Blizard B, Mann A. Does sleep disturbance predict depression in elderly people? A study in inner London. Br J Gen Pract 1993; 43: 445-448
    PubMedGoogle Scholar
  • 5 Wilson S, Argyropoulos S. Antidepressants and sleep: A qualitative review of the literature. Drugs 2005; 65: 927-947
    CrossrefPubMedGoogle Scholar
  • 6 Winokur A, Sateia MJ, Hayes JB et al. Acute effects of Mirtazapine on sleep continuity and sleep architecture in depressed patients: A pilot study. Biol Psychiatry 2000; 48: 75-78
    CrossrefPubMedGoogle Scholar
  • 7 Schittecatte M, Dumont F, Machowski R et al. Effects of mirtazapine on sleep polygraphic variables in major depression. Nueropsychobiology 2002; 46: 197-201
    PubMedGoogle Scholar
  • 8 Winokur A, DeMartinis NA, McNally DP et al. Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia. J Clin Psychiatry 2003; 64: 1224-1229
    CrossrefPubMedGoogle Scholar
  • 9 Schmid DA, Wichniak A, Uhr M et al. Changes of sleep architecture, spectral composition of sleep EEG, the nocturnal secretion of cortisol, ACTH, GH, prolactin, melatonin, ghrelin, and leptin and the DEX-CRH test in depressed patients during treatment with mirtazapine. Neuropsychopharmacology 2006; 31: 832-844
    CrossrefPubMedGoogle Scholar
  • 10 Sadeh A, Hauri P, Kripke DF et al. The role of actigraphy in the evaluation of sleep disorders. Sleep 1995; 18: 288-302
    PubMedGoogle Scholar
  • 11 Cole RJ, Kripke DF, Mullaney DJ. Automatic sleep/wake identification from wrist activity. Sleep 1992; 15: 461-469
    PubMedGoogle Scholar
  • 12 Ferrando L, Bobes J, Gibert J et al. Mini International Neuropsychiatric Interview. En: Bobes J, Bousoño M, González MP. (eds.) Manejo de los trastornos mentales y del comportamiento en Atención Primaria. 2ª ed. Oviedo: Gofer; 1997
    Google Scholar
  • 13 Sheehan DV, Lecrubier Y, Sheehan KH et al. The MiniInternational Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (Suppl. 20) 22-23 34-57
    Google Scholar
  • 14 Montgomery SA, Asberg MA. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382-389
    CrossrefPubMedGoogle Scholar
  • 15 Martínez R, Burgeois M, Peyre F et al. Validity study of the Montgomery and Asberg’s depression Scale. Revista Asociación Española Neuropsiquiátrica 1991; 11: 9-14
    PubMedGoogle Scholar
  • 16 Buysse DJ, Reynolds III ChF, Monk TH et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research 1989; 28: 193-213
    CrossrefPubMedGoogle Scholar
  • 17 Jiménez-Genchi A, Monteverde E, Nenclares A et al. Confiabilidad y análisis factorial de la versión en español del Índice de Calidad de Sueño de Pittsburgh en pacientes psiquiátricos. Gaceta de la Academia Mexicana de Medicina 2008; 144: 491-496
    PubMedGoogle Scholar
  • 18 Actiwatch. Activity monitors. Instruction Manual 2001
    PubMedGoogle Scholar
  • 19 Van den Berg J, Frank JA, Van Rooij HV et al. Disagreement between subjective and actigraphic measures of sleep duration in a population-based study of elderly persons. J Sleep Res 2008; 17: 295-302
    CrossrefPubMedGoogle Scholar
  • 20 Van den Berg JF, Miedema HM, Tulen JHM et al. Sex differences in subjective and actigraphic sleep measures: A population based study of elderly persons. Sleep 2009; 32: 1367-1375
    PubMedGoogle Scholar
  • 21 Schatzberg A. Mirtazapine. In: Schatzberg A, Nemeroff CB. (eds.) Textbook of Psychopharmacology. 3rd ed. USA: American Psychiatric Publishing, Inc.; 2004
    Google Scholar
  • 22 Smith NIT, Glaudin V, Panagides J et al. Mirtazapine vs. amitriptyline vs. placebo in the treatment of major depressive disorder. Psychopharmacol Bull 1990; 26: 191-196
    PubMedGoogle Scholar
  • 23 Apiquian R, Fresán A, Muñoz-Delgado J et al. Variations of the rest-activity rhythm in schizophrenic patients vs healthy subjects: An Actigraphic comparative study. Biological Rhythm Research 2008; 39: 69-78
    CrossrefPubMedGoogle Scholar
  • 24 Leibenluft E, Frank E. Circadian rhythms in affective disorders. In: Takahashi J, Turek F, Moore R. (eds.) Handbook of Behavioral Neurobiology: Circadian Clocks. New York, NY, USA: Kluwer Academic/Plenum; 2001: 625-644
    CrossrefGoogle Scholar
  • 25 Salgado-Delgado R, Tapia Osorio A, Saderi N et al. Disruption of Circadian Rhythms: A crucial Factor in the Etiology of Depression. Depress Res Treat 2011; : 1-9
    PubMedGoogle Scholar