Venlafaxine-mirtazapine combination in the treatment of persistent depressive illness.

The combination of mirtazapine and venlafaxine has been suggested as a treatment option for difficult to treat depressive illness. We describe 32 patients with persistent depressive illness (44% male; mean age 42 years; mean 2.5 previous antidepressant trials) that received mirtazapine and venlafaxine in combination at some point over the 3 year period between 2002 and 2005. Clinical response rates (CGI-improvement score of two or less) were 44% at 4 weeks and 50% at 8 weeks. At 6 month review, 18 patients (56% of the original cohort and 75% of those still receiving treatment) had significantly responded. Clinical response typically occurred at moderate and high dose treatment with both agents. A total of 44% experienced some adverse effects with sedation (19%) and weight gain (19%) most frequent. Five patients discontinued treatment due to these effects. No serious adverse effects were linked to the combination treatment. We discuss the implications of these findings for the use of venlafaxine and mirtazapine in combination in more difficult to treat patients with depression.