{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:37:39Z","timestamp":1785285459003,"version":"3.55.0"},"reference-count":33,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["11\/129\/76"],"award-info":[{"award-number":["11\/129\/76"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Psychopharmacol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is a lack of evidence to guide treatment of comorbid depression and anxiety. Preliminary evidence suggests mirtazapine may be effective in treating patients with both depression and anxiety symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We undertook a secondary analysis of mirtazapine (MIR): a placebo-controlled trial of the addition of mirtazapine to a selective serotonin reuptake inhibitor or serotonin\u2013norepinephrine reuptake inhibitor in treatment-resistant depression (TRD) in primary care. We subdivided participants into three groups by baseline generalized anxiety disorder score (GAD-7): severe (GAD-7 \u2a7e 16), moderate (GAD-7 = 11\u201315), no\/mild (GAD-7 \u2a7d 10). We used linear regression including likelihood-ratio testing of interaction terms to assess how baseline anxiety altered the response of participants to mirtazapine as measured by 12-week GAD-7 and Beck Depression Inventory II (BDI-II) scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Baseline generalized anxiety moderated mirtazapine\u2019s effect as measured by GAD-7 ( p = 0.041) and BDI-II ( p = 0.088) at 12\u2009weeks. Participants with severe generalized anxiety receiving mirtazapine had lower 12-week GAD-7 score (adjusted difference between means (ADM) \u22122.82, 95% confidence interval (CI) \u22120.69 to \u22124.95) and larger decreases in BDI-II score (ADM \u22126.36, 95% CI \u22121.60 to \u221210.84) than placebo. Conversely, there was no anxiolytic benefit (ADM 0.28, 95% CI \u22121.05 to 1.60) or antidepressant benefit (ADM \u22120.17, 95% CI \u22123.02 to 2.68) compared with placebo in those with no\/mild generalized anxiety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These findings extend the evidence for the effectiveness of mirtazapine to reduce generalized anxiety in TRD in primary care. These results may inform targeted prescribing in depression based on concurrent anxiety symptoms, although these conclusions are constrained by the post-hoc nature of this analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0269881120965939","type":"journal-article","created":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T04:08:45Z","timestamp":1604462925000},"page":"1342-1349","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Does anxiety moderate the effectiveness of mirtazapine in patients with treatment-resistant depression? A secondary analysis of the MIR trial"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1230-0847","authenticated-orcid":false,"given":"Raphael","family":"Rifkin-Zybutz","sequence":"first","affiliation":[{"name":"Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"MacNeill","sequence":"additional","affiliation":[{"name":"Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon JC","family":"Davies","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Dickens","sequence":"additional","affiliation":[{"name":"Mental Health Research Group, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Campbell","sequence":"additional","affiliation":[{"name":"Academic Primary Care, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2205-9209","authenticated-orcid":false,"given":"Ian M","family":"Anderson","sequence":"additional","affiliation":[{"name":"Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn A","family":"Chew-Graham","sequence":"additional","affiliation":[{"name":"School of Primary, Community and Social Care, Keele University, Keele, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim J","family":"Peters","sequence":"additional","affiliation":[{"name":"Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glyn","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Wiles","sequence":"additional","affiliation":[{"name":"Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kessler","sequence":"additional","affiliation":[{"name":"Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, 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