Low-dose mianserin as adjuvant therapy in obese patients treated by a very-low-calorie diet

A double blind trial examined the effects of low doses of the anti-depressant compound mianserin (10 mg nocte, Organon, Oss, Holland) on dietary compliance and weight loss in 45 obese subjects treated by a very-low-calorie diet (VLCD, 320 kcal (1.34 MJ)/day) for 16 weeks. The total mean weight loss of the 25 patients who completed the trial was 15.5 kg +/- 6.1 s.d. There was no significant difference in weight loss between the groups. More patients taking placebo (54 per cent vs 38 per cent) completed the experiment. Three patients stopped mianserin because of drowsiness, but were able to continue on the VLCD alone. Beck rating scores decreased (indicating less depression) in both groups by 50 per cent after eight weeks. With the linear self-rating scale there was no change in the placebo group but the mianserin group reported feeling less depressed (P less than 0.001). No significant changes were observed in ECG and routine clinical and laboratory tests. It is concluded that VLCD can be a safe and acceptable means of achieving substantial weight loss over several months. Patients do not become more depressed during treatment and there is no clinical advantage to be gained by the routine additional use of low doses of mianserin.