Mianserin and clomipramine in the treatment of depression

Forty-two patients aged between 19 and 70 years (30 women and 12 men) suffering from primary unipolar depression were randomly selected and treated under double-blind conditions with either mianserin (Lantanon; Organon) or clomipramine (Anafranil; Ciba-Geigy) after an initial wash-out period. Patients on all other medication, including benzodiazepines, were excluded from the study. The severity of depression was assessed on day 0 and after 1, 2, 3, 4 and 5 weeks' treatment. There were no significant pretrial differences between the groups in respect of severity of depression, age, sex or previous psychiatric history. During the 1st week of treatment all subjects received either mianserin 30 mg or clomipramine 75 mg once daily. From the 2nd week onwards the dose was doubled. Thirty patients completed the trial, 16 on mianserin and 14 on clomipramine. The improvement on both treatments was marked, favouring mianserin but only reaching significance in the 5th week. Side-effects, especially tremor, tachycardia, dystonia, dizziness, excitement, nasal congestion and dry mouth, were significantly more common in the group using clomipramine. This study confirms reports that mianserin is an effective antidepressant which is better tolerated and produces fewer side-effects (especially anticholinergic) than comparable tricyclic antidepressants such as clomipramine.