The use of mirtazapine in difficult-to-treat patient populations.

Patients who have failed previous antidepressant treatment present substantial clinical management challenges. Similarly, elderly patients require special attention. Three recent studies have shown that mirtazapine has a role to play in the management of these patients. Mirtazapine has proved effective in the treatment of patients who were resistant or intolerant to selective serotonin reuptake inhibitors (SSRIs) and the switch to mirtazapine could be made immediately without the necessity for a taper period. In a double-blind study in patients who were resistant to SSRI treatment, mirtazapine had a more rapid onset of action than sertraline. Mirtazapine has also proved effective in elderly depressed patients and again showed a faster onset of action than another of the SSRIs, paroxetine.