In a randomized, placebo-controlled pilot study (J Tack et al. Clin Gastroenterol Hepatol 2016; 385-92) with 34 patients (29 women, median age 35.9 years), the authors showed improved dyspepsia symptom scores at weeks 4 and 8 compared with baseline.
Background: Mirtazapine is an antidepressant which is associated with weight gain and improvement in nausea.
Methods: The treatment group received 15 mg each day.
- Compared with the control group, these was improvement in early satiety, quality of life, GI-specific anxiety, nutrient tolerance, and weight loss.
- Two patients in the treatment group dropped out due drowsiness. Interestingly, the trend of improvement was greater at week 4 then for week 8.
- The authors note that epigastric pain and burning did not improve.
Limitations: small number of patients, and tertiary care patient population
My take: more studies are needed for this vexing problem
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