Depression in Alzheimer's Disease Significantly Improved under Treatment with Mianserine

Abstract

To the Editor:—Depression is a frequent unspecific behavioral concomitant of Alzheimer's disease. Typically, the mood disorder is shortlived and fluctuating but may meet the diagnostic criteria for major depression in up to 30% of all cases.1 The efficacy of antidepressant treatment in demented patients has been observed using compounds such as monoamine-oxidase inhibitors2,3 or imipramine.4 There are no reports on the effects of the tetracyclic antidepressant mianserine on depression in Alzheimer's disease although this compound, a dipyrazinoazepine derivate, may be particularly useful in elder patients because it shows little vegetative and almost no anticholinergic side effects. In our outpatient clinic a 79-year-old woman, with clinically diagnosed moderate Alzheimer's disease (NINCDS-ADRDA), complaining of depressed mood, low self-esteem, and anxiety showed markedly reduced drive and mentioned occasional suicidal thoughts. She had lost interest in social activities during the past 4 weeks. The criteria for major depression (DSM-III-R) were fulfilled. Treatment was begun with mianserine 10 mg/day and after 1 week was raised to 20 mg/day. Two weeks after initial treatment, her symptoms of anxiousness, depression, drive, and self-esteem had improved clinically. According to her husband, suicidal thoughts were no longer present, and she had even started to participate in some activities (taking a walk, visiting friends). Six weeks after initial treatment, further substantial improvement of depression was clinically demonstrable. The patient could enjoy social activities in daily living. During the follow-up assessment over 6 weeks, no relevant side effects, such as tiredness, sedation or orthostatic hypotension, occurred. There was no change in cognitive impairment during these 6 weeks. The clinical observations were confirmed by baseline and follow-up assessments (Table 1) at 2 and 6 weeks with the Dementia Mood Assessment Scale,5 the Nurses' Observation Scale for Geriatric Patients,6 and the Cambridge Cognitive Examination.7 This case report suggests that treatment with mianserine can substantially improve major depression in Alzheimer patients. We did not find relevant side effects during treatment. In contrast to that, postural hypotension, drowsiness, and dizziness have been reported during treatment of depression in Alzheimer patients with tricyclic antidepressants4 and monoamino-oxidase inhibitors.3 Furthermore, treatment with monoamino-oxidase inhibitors requires dietary precautions to prevent potential hypertensive reactions.8 We therefore suggest that the tetracyclic antidepressant mianserine should be considered as a valuable alternative in the pharmacological treatment of depression in Alzheimer's patients.