PEP Topic 
Chemotherapy-Induced Nausea and Vomiting—Adult

Mirtazapine is in a class of medications called antidepressants. It also has been used as an antianxiety medication, antiemetic, and appetite stiumulant. It works by enhancing adrenergic and serotonergic neurotransmitter activity in the brain. Mirtazapine is also an antagonist of 5-HT3 and histamine receptors. Mirtazapine is available as a tablet and  an oral disintegrating tablet. As with other antidepressants, patients may need to take mirtazapine for several weeks to experience the full benefits and it may cause withdrawal symptoms on discontinuation. Mirtazapine has been evaluated for anorexia, chemotherapy-induced nausea and vomiting, depression, sleep-wake disturbances, and hot flashes.

Effectiveness Not Established

Research Evidence Summaries

Kim, S., Shin, I., Kim, J., Kim, Y., Kim, K., Kim, K., … Yoon, J. (2008).  Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression. Psychiatry and Clinical Neurosciences, 62, 75-83.

doi: 10.1111%2Fj.1440-1819.2007.01778.x

Study Purpose:

To evaluate the effectiveness of mirtazapine for nausea and insomnia in patients with cancer with depression

Intervention Characteristics/Basic Study Process:

Assessments were conducted at baseline and on days 1, 3, 5, 7, 14, and 28 by trained psychiatrists in an outpatient clinic. In addition, side effects were assessed with each visit. This was a four-week study.

Sample Characteristics:

  • The study consisted of 28 patients with cancer with depression.
  • Patients were eligible if they had a malignant cancer with nausea or insomnia and met the Diagnostic and Statistical Manual for Mental Disorders VI diagnostic criteria for major depression.
  • Participants were excluded if they were taking other antidepressants to control depressive symptoms.


Participants were recruited from a university cancer center in Korea.

Study Design:

This was a prospective, open-label study.

Measurement Instruments/Methods:

The following measurement tools were used.

  • Clinical Global Impression Scale for Nausea and Vomiting
  • Chonnam National University Hospital-Leeds Sleep Evaluation Questionnaire
  • Montgomery-Asberg Depression Rating Scale (MADRS)
  • Euro-Qol (EQ-5D) Short Form Health Survey (SF-36)


  • Most patients (93%) experienced significantly improved nausea from day 1 without increasing dosages or adding antiemetics.
  • The subjects were divided into two groups: patients undergoing chemotherapy (n = 11) and those not undergoing chemotherapy (n = 17). The improvement was sustained in both groups; however, changes in nausea were greater for patients receiving chemotherapy.
  • Total night sleep time improved from days 1-5.
  • A reduction in scores for pain and anxiety were found on the MADRS and the VAS of EQ-5D.


Mirtazapine rapidly improved nausea, sleep disturbance, pain, depression, and quality of life for patients with cancer.


  • A possible placebo effect may have influenced the results.
  • This was not a controlled trial.
  • The sample size was small and a large number of variables existed.
  • The physical status, symptom of depression, frequency and length of assessments, and outpatient clinic visits for the assessment may have contributed to a high participant dropout rate.