Escitalopram and Mirtazapine For the Treatment of Depression in Hiv Patients: A Randomized Controlled Open Label Trial

Objective: the objective of this study was to compare the safety and efficacy of mirtazapine and escitalopram in hiv patients for the treatment of depression. methods: in this trial, 70 adult hiv patients with major depression were randomized and assigned to receive 8 weeks of daily open label mirtazapine (5-30 mg) or escitalopram (7.5-20 mg). the primary outcome variables were endpoint response in hamilton rating scale for depression (ham-d) score and change of ham-d score from baseline to endpoint. patients having improvement of > 50% on the ham-d total scores during treatment were considered to have responded. a final 17-item ham-d total score of 8 or less defined remission. results: the response rate was 91.4 % (32/35) in mirtazapine group and 85.7 % (30/35) in escitalopram group (p= 0.71). the remission rate was more in escitalopram group (48.6 %, 17/35) compared to mirtazapine group (34.3 %, 12/35); however it was not statistically significant (chi square (1, n = 70) = 2.1, p = 0.22). after controlling for baseline score, the median hamd score at 8 weeks was significantly lower in the mirtazapine group (median (mdn)=4, interquartile range (iqr)= 11) compared to escitalopram group (mdn=13, iqr= 12) (p < 0.001). the number of adverse events reported was more in escitalopram group (110) than mirtazapine group (85); however this was not statistically significant (p= 0.34). conclusions: both these drugs are useful in the management of depression in hiv patients and need further study