Mianserin is better tolerated and more effective in depression than a nomifensine-clobazam combination: a double-blind study.

Patients suffering from depression (mostly depressive neurosis) were admitted to a double-blind study which compared the efficacy of a combination of nomifensine and clobazam with mianserin. Therapeutic efficacy was evaluated on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Clinical Global Impression Scale, physician's assessments, Global Improvement and Treatment Emergent Symptom Scale for side-effects. Assessments were made before admission to the trial and on days 3, 7, 14 and 21. Forty patients were randomly allocated to two treatment groups. A case is made against polypharmacy and in particular against the use of benzodiazepine combinations in depression. Nineteen patients on nomifensine-clobazam and 14 on mianserin completed the three-week trial. At 7, 14 and 21 days, the Hamilton Depression Rating Scale (HDRS) total scores were significantly improved for mianserin when compared with nomifensine-clobazam. Similarly, at 7 and 14 days the Hamilton Anxiety Rating Scale (HARS) total scores were significantly better for mianserin than for the nomifensine-clobazam combination. There were also significant improvements for mianserin on the HDRS sub-scales of anxiety somatization, cognitive disturbance and sleep disturbance. There were no significant differences for HDRS somatic symptoms between treatment groups. Drowsiness was the most common side-effect in both groups. The incidence of total side-effects was 74% for nomifensine-clobazam and 71% for the mianserin group.