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Gregory J. Riely, MD, PhD


Using an Antidepressant to Improve Appetite and Energy in Patients With NSCLC

By: Chris Schimpf, BS
Posted: Wednesday, April 3, 2024

The antidepressant mirtazapine may be effective in helping patients with both advanced non–small cell lung cancer (NSCLC) and anorexia to meet their energy needs, according to research published in JAMA Oncology. In their randomized clinical trial, Oscar Arrieta, MD, MSc, of the National Cancer Institute of Mexico, Mexico City, and colleagues found that patients who received mirtazapine during cancer treatment had a significant increase in energy intake, and this increase was mainly in fat intake—a crucial source of energy. Citing the lack of standard therapy to improve cancer-related anorexia, the investigators noted their findings have the potential to improve health-related quality of life for this patient population.

A total of 86 patients receiving first-line treatment for stage 4 NSCLC were included in the randomized, double-blind, placebo-controlled clinical trial. Participants were randomly assigned to receive either mirtazapine or a placebo, and both groups received dietary advice and nutritional assessments. Dietary parameters were evaluated at baseline, 4 weeks, and 8 weeks using a 24-hour dietary recall and energy quantification based on the Mexican system of nutritional equivalents. Appetite was assessed by the Anorexia Cachexia Scale and energy intake.

The investigators reported the baseline characteristics were similar between the two groups, and there was no difference in appetite scores at 4 and 8 weeks of follow-up. After 4 weeks, they found mirtazapine significantly increased energy intake (379.3 kcal; 95% confidence interval [CI] = 1,382.6–576.1; P < .001), including proteins (22.5 g; 95% CI = 11.5–33.4; P = .001), carbohydrates (43.4 g; 95% CI = 13.1–73.8; P = .006), and fats (13.2 g; 95% CI = 6.0–20.4; P = .006). They also found that fat intake was significantly higher in patients who received mirtazapine (14.5 g vs 0.7 g; P = .02) after 8 weeks. In addition, at 8 weeks, they observed a significant decrease in the proportion of patients with sarcopenia among those who received mirtazapine (82.8% vs 57.1%; P = .03).

Disclosure: For full disclosures of the study authors, visit

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