Antidepressant Ineffective for Severe Breathlessness: A Critical Analysis

An inexpensive antidepressant was recently tested in a phase III trial for its efficacy in alleviating severe breathlessness in patients with chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD). However, the results of the trial were disappointing, showing no significant difference between the antidepressant and a placebo in terms of reducing breathlessness.

Study Design and Findings

The trial, called BETTER-B, randomized 225 patients with severe breathlessness from COPD, ILD, or both to receive either daily mirtazapine (15 mg, escalating to 45 mg) or a placebo. The primary outcome of “worst breathlessness” over the past 24 hours showed no difference between the two groups after 56 days of treatment. In fact, scores on the numeric rating scale (NRS) for breathlessness remained almost the same in both groups, with a minimal between-group difference.

The study’s lead researcher, Irene Higginson, expressed disappointment at the results and cautioned against the use of off-label medications for severe breathlessness. Despite the biological plausibility of mirtazapine in reducing panic associated with breathlessness, the study showed no benefit in terms of symptom relief.

Implications for Clinical Practice

The findings of the trial have significant implications for clinical practice, as they highlight the limitations of using antidepressants for severe breathlessness. Healthcare professionals need to exercise caution when prescribing off-label medications and consider alternative approaches to managing breathlessness in patients with COPD or ILD.

Future research in this area should focus on identifying more effective therapies for alleviating severe breathlessness in patients with COPD or ILD. Individualized approaches to care that address the physical, psychological, social, and spiritual aspects of breathlessness should be explored to provide comprehensive support to patients.

The study on the efficacy of mirtazapine for severe breathlessness in patients with COPD and ILD did not produce favorable results. Healthcare professionals should be cautious when considering off-label medications for symptom management and explore alternative strategies to improve the quality of life for patients with chronic respiratory conditions. Further research is needed to identify more effective interventions for addressing severe breathlessness in this population.