1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
2 Palliative Medicine, Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
Palliat Med. 2018 Oct;32(9):1518-1521. doi: 10.1177/0269216318787450. Epub 2018 Jul 20.
Breathlessness remains a common and distressing symptom in people with advanced disease with few effective treatment options. Repurposing of existing medicines has been effective in other areas of palliative care, for example, antidepressants to treat pain, and offers an opportunity to deliver improved symptom control in a timely manner. Previous case series have shown reduced breathlessness following the use of sertraline (a selective serotonin reuptake inhibitor) in people with chronic obstructive pulmonary disease.
Six cases where mirtazapine, a noradrenergic and specific serotonergic antidepressant, was used to treat chronic breathlessness in advanced lung disease. Case management: All cases received mirtazapine at a starting dose of 15 mg, prescribed under the care of their primary care physician. Cases had been receiving mirtazapine for a variable time period (2 weeks to 5 months) at the time of the interviews. Case outcome: All cases reported less breathlessness and being able to do more. They described feeling more in control of their breathing, and being able to recover more quickly from episodes of breathlessness. Some cases also reported beneficial effects on anxiety, panic, appetite and sleep. No adverse effects were reported.
Patients with chronic breathlessness in this case series reported benefits during mirtazapine treatment. To determine the effectiveness of mirtazapine in alleviating breathlessness and improving quality of life in chronic lung disease, blinded randomised trials are warranted.
在晚期疾病患者中，呼吸困难仍然是一种常见且令人痛苦的症状，且治疗选择有限。在姑息治疗的其他领域，例如使用抗抑郁药来治疗疼痛，重新利用现有药物已经取得了成效，这为及时提供改善症状控制提供了机会。先前的病例系列研究表明，使用选择性 5-羟色胺再摄取抑制剂（SSRIs）舍曲林可以减轻慢性阻塞性肺疾病患者的呼吸困难。
6 例使用米氮平（一种去甲肾上腺素和特异性 5-羟色胺能抗抑郁药）治疗晚期肺部疾病慢性呼吸困难的病例。病例管理：所有病例均由初级保健医生开具米氮平起始剂量 15mg 进行治疗。在接受访谈时，这些病例使用米氮平的时间长短不一（2 周至 5 个月）。病例结果：所有病例均报告呼吸困难减轻，活动能力增强。他们表示呼吸控制感增强，并且能够更快地从呼吸困难发作中恢复。一些病例还报告对焦虑、恐慌、食欲和睡眠有有益影响。未报告不良反应。
本病例系列中的慢性呼吸困难患者在米氮平治疗期间报告了获益。为了确定米氮平在缓解慢性肺部疾病患者的呼吸困难和改善生活质量方面的有效性，需要进行盲法随机试验。
