A Comparison of Mirtazapine and Paroxetine for the Treatment of Patients with Posttraumatic Stress Disorder: A Randomized Open-label Trial

Objective: The present study compared the efficacy and tolerability of treatment with mirtazapine and paroxetine for patients with posttraumatic stress disorder (PTSD). Methods: Forty subjects with PTSD were randomly assigned to the mirtazapine or paroxetine treatment group. The drugs were administered for 8 weeks with a flexible dosing schedule, and the clinician-administered PTSD scale (CAPS-2) was used to evaluate clinical symptoms at the baseline and at weeks 2, 4, and 8. Treatment responsiveness was defined as a ≥30% decrease in the CAPS-2 total score from the baseline. Results: After 8 weeks, a significant decrease in the mean CAPS-2 score compared with the baseline was observed in both treatment groups. However, the mean change in the CAPS-2 score did not differ between the treatment groups at any point over the study period. At 8 weeks, the response rate was 70% for the mirtazapine group and 85% for the paroxetine group. No serious adverse reaction was noted in either treatment group, and both drugs were well tolerated. Conclusion: The results of this study support a possible role for mirtazapine in the treatment of PTSD symptoms. To reach a more definite conclusion, larger double-blind, placebo-controlled, head-to-head comparison studies are needed.