Talk:Mirtazapine

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Video Talk:Mirtazapine

2010 UK Study

2010 follow up study comparing 14 antidepressants meets all MEDRS criteria and is fairly comprehensive if one takes time to read it. Yes Jytdog you have completely removed all mention of it along with 2009 study. 2009 study can be replaced as it is outdated. But 2010 study with statistically significant results needs to be mentioned if those are also mentioned for escitalopram, venlafaxine and sertraline. If I revert your edit you will claim edit war. Double standard here. For some reason it seems you are portraying that you really have no interest in the improvement of this particular article. You only seem interested in downgrading the page so that you don't have to monitor it at all. I am not being personal here and not even attacking you, but last few edits are really COI and POV based reeking of bias, at least from an outside perspective. Do you have COI here? -- Preceding unsigned comment added by 112.79.142.13 (talk) 09:04, 22 July 2017 (UTC)

Please read the entire NICE study and its recommendations. I quote "There is evidence suggesting that there is a statistically significant difference favouring mirtazapine over SSRIs on reducing symptoms of depression by the end of treatment, but the size of this difference is unlikely to be of clinical importance". Also "There is evidence suggesting that there is a statistically significant difference favouring mirtazapine over other antidepressants on increasing the likelihood of achieving remission by the end of treatment as measured by the HRSD".

"There is strong evidence suggesting that there is a clinically important difference favouring mirtazapine over other antidepressants on reducing the likelihood of patients leaving treatment early due to side effects (K ? 15; N ? 2637; RR ? 0.69; 95% CI, 0.55 to 0.87)." Results from NICE Study "Mirtazapine appears to be the most cost-effective option among those assessed for both moderate and severe depression, producing the highest number of QALYs and the lowest costs among all drugs assessed (dominant option)." -- Preceding unsigned comment added by 112.79.142.13 (talk) 09:15, 22 July 2017 (UTC)

Just comparing it with SSRIs doesn't make sense now since SSRIs are a generation behind the more commonly prescribed SNRIs and a generation behind Mirtazapine (except escitalopram). So the statistical evidence of comparison of 14 most commonly prescribed treatments should be mentioned as I had mentioned. -- Preceding unsigned comment added by 112.79.142.13 (talk) 09:23, 22 July 2017 (UTC)

I think I will go ahead and request page protection of Mirtazapine from harmful edits. 112.79.142.13 (talk) 11:14, 22 July 2017 (UTC)

User:112.79.142.13, about this:

A 2010 NICE study comparing 14 most common antidepressants found Mirtazapine as the most efficacious and cost-effective treatment for moderate to severe depression.

The table you are citing, is directly from the Cipriani et al. (2009) ref.

What NICE itself recommends, is described now in this article via this diff, which I will quote below:

NICE published a guideline for treating depression that included a review of antidepressants. It recommended generic SSRIs as first line choices, as they are "are equally effective as other antidepressants and have a favourable risk-benefit ratio." With respect to mirtazapine, it found: "There is no difference between mirtazapine and other antidepressants on any efficacy measure, although in terms of achieving remission mirtazapine appears to have a statistical though not clinical advantage. In addition, mirtazapine has a statistical advantage over SSRIs in terms of reducing symptoms of depression, but the difference is not clinically important. However, there is strong evidence that patients taking mirtazapine are less likely to leave treatment early because of side effects, although this is not the case for patients reporting side effects or leaving treatment early for any reason."

With regard to the economic analysis section, the NICE paper says the following:

These findings highlighted the need for de novo economic modelling for this guideline. The objective of economic modelling was to explore the relative cost effectiveness of antidepressants for people with depression in the current UK clinical setting, incorporating the results of a recently published network meta-analysis (Cipriani et al., 2009), as described in Section 10.11.....The choice of interventions assessed in the model was determined by the antidepressants included in the network meta-analysis by Cipriani and colleagues (2009).

... 10.12.6. Conclusions

The findings of this preliminary economic analysis suggest that mirtazapine might be more cost effective than other antidepressants in the treatment of people with moderate and severe depression and support the findings of Cipriani and colleagues (2009) regarding the clinical superiority of mirtazapine. However, these economic findings are subject to considerable uncertainty arising from the limitations of the current model and lack of incorporation of data on the relative adverse effects of the drugs in the model. Addressing these issues may alter the outcome of the model.

The two key things from this are:

1. The authors were developing a model and used the Cipriani analysis as a basis for that
2. The authors themselves do not consider the results definitive, and indeed the final recommendations for drug selection do not take this analysis into account. NICE recommends SSRIs as first choice drugs.

We cannot give more WEIGHT to this part of the NICE analysis, than NICE itself did. Please stop doing that.

The Cipirani study was published in 2009 and that is now too old per MEDDATE. Even the 2010 NICE study and the 2011 Cochrane review are too old but those are the most recent things we have. And they do not agree at all with the content you keep trying to add in that mirtazapine is The Best. The content you are adding, that I cited at the top of my response, misrepresents what NICE actually recommends.

Also please stop capitalizing the name of the generic drug. =

Jytdog (talk) 14:15, 22 July 2017 (UTC)

Have you read the 'Results' section, at all? What you are citing is the discussion and by saying they were developing the model you have completely ignored the 2009 study which was the basis of the 2010 study.

Results from NICE Study "Mirtazapine appears to be the most cost-effective option among those assessed for both moderate and severe depression, producing the highest number of QALYs and the lowest costs among all drugs assessed (dominant option)."

Is that wrong? Or am I just an idiot and you have all the better info right? -- Preceding unsigned comment added by 112.79.155.168 (talk) 14:26, 22 July 2017 (UTC)

As I noted above, you are accurately quoting a section of the NICE recommendations, but a) that section itself notes that it was modelling things and that its results were provisional and b) the actual recommendations for drug selection do not reference that work at all. The actual recommendation for 1st line treatment are SSRIs. You cannot make it seem as though NICE recommended something that it did not or that NICE itself found the economic analysis very important (again, NICE itself did not use it, in the recommendations it made in the same document). We call the problem you are creating WP:UNDUE. Jytdog (talk) 15:34, 22 July 2017 (UTC)

Official Request for full page protection has been raised at the Page protection requests. Please don't edit the page further as this would constitute an edit war for which I will be notifying respective admins and also for possible case of COI. -- Preceding unsigned comment added by 112.79.155.168 (talk) 14:39, 22 July 2017 (UTC)

@Fuse809 The NICE study of which the tables are a part of include 14 most common antidepressants including St. John's Wort.

Why wouldn't a drug name be a proper noun? The word has no other connotation or usage. Its like the name of a person. It's not a common thing so its not a common noun. Original and non-repetitve names are proper noun by convention. -- Preceding unsigned comment added by 112.79.155.168 (talk) 15:10, 22 July 2017 (UTC)

We do not capitalize generic drugs names anywhere in Wikipedia. They are not proper nouns any more than "book" is a proper noun. Jytdog (talk) 15:31, 22 July 2017 (UTC)

Source of the article : Wikipedia