{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T13:57:07Z","timestamp":1774447027631,"version":"3.50.1"},"reference-count":77,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Human Psychopharmacology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) with sedative features that may be advantageous for anxiety and trauma\u2010related disorders, yet its role remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically reviewed and meta\u2010analyzed the evidence on mirtazapine in anxiety disorders, major depressive disorder evaluating anxious symptoms, and trauma\u2010related disorders, following PRISMA guidelines. Following a pre\u2010registered protocol (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/osf.io\/562zj\/?view_only=0f596df97bc74b2bb25ebbf1dcbd7589\">https:\/\/osf.io\/562zj\/?view_only=0f596df97bc74b2bb25ebbf1dcbd7589<\/jats:ext-link>\n                      ), we searched PubMed\/EMBASE\/CENTRAL\/ClinicalTrials.gov\/WHO\u2010ICTRP from inception until 07\/07\/2025. The co\u2010primary outcomes were efficacy (symptom decrease\u2014Standardized Mean Difference\/SMD and response\u2014Risk Ratio\/RR) and acceptability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 799 identified records, 37 studies were included. In generalized anxiety disorder (GAD), mirtazapine paralleled selective serotonin reuptake inhibitors (SSRIs) (SMD\u00a0=\u00a0\u22120.14, 95% C.I. [\u22120.38, 0.09],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.23, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a013.3%,\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.01,\n                      <jats:italic>k<\/jats:italic>\n                      \u00a0=\u00a05,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0330), benzodiazepines (SMD\u00a0=\u00a0\u22120.03, 95% C.I. [\u22120.83, 0.77],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.94, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a085.9%,\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.43,\n                      <jats:italic>k<\/jats:italic>\n                      \u00a0=\u00a04,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0233). In major depressive disorder (MDD), mirtazapine slightly outperformed SSRIs regarding anxiety (SMD\u00a0=\u00a0\u22120.16, 95% C.I. [\u22120.25, 0.07],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%,\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00,\n                      <jats:italic>k<\/jats:italic>\n                      \u00a0=\u00a010,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01732), and paralleled tricyclic antidepressants (TCAs). In post\u2010traumatic stress disorder, SSRI augmentation was effective. Acceptability was comparable to placebo and SSRIs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Mirtazapine was more effective than SSRIs for anxiety in MDD and may be preferred when anxiety is relevant. In GAD, mirtazapine may serve as an alternative to first\u2010line agents, and further regulatory explorations are warranted. In PTSD, mirtazapine has potential as an augmentation strategy. Mirtazapine was generally well tolerated and may be advantageous for patients requiring rapid effect or relief from sleep disturbances.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hup.70037","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T11:36:04Z","timestamp":1773315364000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Potential of Mirtazapine in Anxiety and Trauma\u2010Related Disorders: A Systematic Review and Meta\u2010Analysis of Current Evidence"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6275-0657","authenticated-orcid":false,"given":"Claudio","family":"Caiazza","sequence":"first","affiliation":[{"name":"Azienda Sanitaria Locale Napoli 3 Sud Unit\u00e0 Operativa Centro di Salute Mentale 55\u201057 Torre del Greco\u2014Ercolano  Naples 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