Off-label use of mirtazapine for anxiety

Abstract Introduction: Currently, mirtazapine is only approved for use in patients with major depressive disorder, yet the unique dual mechanism of action for this agent has led many to inquire about potential alternative uses. The purpose of this article is to review the evidence available and evaluate the efficacy and tolerability of mirtazapine for use in patients presenting with various forms of anxiety. Methods: A search of the medical literature using Ovid Medline and the search terms “mirtazapine” and “anxiety disorders” resulted in the identification of 12 trials and 1 meta-analysis investigating off-label mirtazapine use in various subsets of anxiety. Results: Upon review of the literature, mirtazapine was found to perform significantly better than placebo at controlling symptoms of anxiety with comorbid depression, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and social anxiety disorder; and with comparable efficacy, in some cases with significantly better respon...