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Revista del Hospital Psiquiátrico de
La Habana
Volumen 21 | No 3 | Año 2024 |
ISSN: 0138-7103 | RNPS: 2030
_____________________________________________
Artículo original
Effect of Mirtazapine on Improving the Quality of Life in
Breast Cancer Patients
Efecto de la mirtazapina en la calidad de vida de pacientes con
cáncer de mama
Houman Kamranian
1
Seyed Alireza Javadinia
1
Elham Khakshour
1
Babak PeyroShabany
1
Elham Navipour
1
Danial Kamrani
1
Zeinab Jalambadani
1
1
University of Medical Sciences, Sabzevar, Iran
Recibido: 31/07/2024
Aceptado: 10/10/2024
Effect of Mirtazapine Medication on Improving the Quality of Life in Breast Cancer Patients
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Abstract
Introduction:
Mirtazapine is an antidepressant drug with serotonergic and noradrenergic effects,
which is used to treat various cancer symptoms.
Objective:
Describe the effect of Mirtazapine medication on improving the quality of life in breast
cancer patients, in Sabzevar, Iran.
Methods:
This study was conducted as a randomized controlled clinical trial on two groups of breast
cancer patients referred to the chemotherapy and radiotherapy center at Vasei Educational Hospital in
Sabzevar, Iran, in 2022. After random assignment, the research had 55 patients in the intervention
group (Mirtazapine) and 55 in the control group. The intervention group received Mirtazapine
medication for 8 weeks under the supervision of a psychiatrist, at a daily dose of 15-30 milligrams.
After 8 weeks, all patients were asked to complete a quality-of-life questionnaire again. The data was
analyzed using SPSS 24 software and a t-test, and chi-square test, with a significance level of 0.05.
Results:
The average age of the patients was 54.05±12.91. The two groups were homogeneous in all
quantitative and qualitative variables before the intervention, and there was no significant statistical
difference (p > 0.05).
The comparison of the average variables in the two groups in the field of quality of life after
intervention has been reported to be significant (P = 0.008). Moreover, this comparison in the field of
general health after intervention between the two research groups was not significant (p = 0.779). The
use of Mirtazapine medication in cancer patients significantly improved sleep quality and sexual
relationships, and improved their sexual function, mood, sadness, anxiety, and depression (p <0.001).
Conclusion:
A recent study showed that using Mirtazapine medication in cancer patients enhances
sleep quality, satisfaction in sexual relationships, mood, depression, and anxiety symptoms, and
overall quality of life without affecting the general health subscale.
Keywords:
depression; cancer; quality of life; mirtazapine
Resumen
Introducción:
la mirtazapina es un fármaco antidepresivo con efectos serotoninérgicos y
noradrenérgicos que se utiliza para tratar diversos síntomas del cáncer.
Objetivo:
describir el efecto de la Mirtazapina en la mejora de la calidad de vida de los pacientes con
cáncer de mama.
Métodos:
este estudio se realizó como un ensayo clínico controlado aleatorio en dos grupos de
pacientes con cáncer de mama remitidos al centro de quimioterapia y radioterapia del Hospital
Educativo Vasei de Sabzevar, Irán en 2022. Después de la asignación aleatoria, 55 pacientes
formaron el grupo de intervención (mirtazapina) y 55 en el grupo de control. El grupo de intervención
recibió medicación mirtazapina durante ocho semanas bajo la supervisión de un psiquiatra, en una
dosis diaria de 15-30 miligramos. Después de ocho semanas, se les solicitó a todas las pacientes que
Effect of Mirtazapine Medication on Improving the Quality of Life in Breast Cancer Patients
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completaran nuevamente un cuestionario de calidad de vida. Los datos se analizaron utilizando el
software SPSS 24 y una prueba t y una prueba de chi-cuadrado, con un nivel de significancia de 0,05.
Resultados:
la edad promedio de las pacientes fue de 54,05 ± 12,91. Los dos grupos eran homogéneos
en todas las variables cuantitativas y cualitativas antes de la intervención, y no hubo diferencia
estadísticamente significativa (p > 0,05). La comparación de las variables promedio en los dos grupos
sobre la calidad de vida después de la intervención fue significativa (p = 0,008). Además, la salud
general después de la intervención entre los dos grupos de investigación no fue significativa (P =
0,779). El uso de la mirtazapina en pacientes con cáncer mejoró significativamente la calidad del
sueño, las relaciones sexuales y el estado de ánimo (p < 0,001).
Conclusión:
el estudio mostró que el uso de la medicación Mirtazapina en pacientes con cáncer
mejora la calidad del sueño, la satisfacción en las relaciones sexuales, el estado de ánimo, los síntomas
de depresión y ansiedad y la calidad de vida en general sin afectar la subescala de salud general.
Palabras clave:
depresión; cáncer; calidad de vida; mirtazapina
Introduction
Breast cancer (BC) is the most common and second leading cause of cancer-related
death among women aged 35 to 54 years. According to the latest WHO report in 2020,
2.3 million (11.7 % of newly diagnosed) women worldwide were diagnosed with
breast cancer and 685,000 deaths were recorded as a result of the disease.
(1)
In
general, breast cancer treatment is divided into two groups: local treatment including
surgery and radiotherapy, and systematic treatment groups such as adjuvant and
neoadjuvant chemotherapy, immunotherapy, and hormone therapy. The main
chemotherapy drugs include Doxorubicin, Cyclophosphamide, and Taxanes, which
are often used in combination with each other to treat breast cancer.
(2)
Recent
advances in the management of breast cancer treatment have made the treatment of
this cancer improve the overall survival of patients.
(3)
However, the use of these
treatments has side effects that reduce the quality of life of patients in the long term.
One of the most important issues in clinical research is the assessment of the quality
of life (QOL), which includes patient's feelings about their ability to perform physical,
emotional, and social functions.
(
4
)
The increase in the prevalence of cancer in recent
years and its effects on the physical, psychological, and social dimensions of human
life have caused cancer to be recognized as a major health problem of the century.
Breast cancer, as the most common female cancer, has an important role in this
problem. The impact of treatment methods on the survival of breast cancer patients
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is an important goal in health care as well as their mental and psychological health in
studies due to the high prevalence of breast cancer in women and the therapeutic
advances that have led to the long survival of patients.
(5)
Paying attention to other
aspects of breast cancer, including the side effects of treatment that affect the quality
of life of patients, can help improve the quality of life and mental health of patients.
One of the common side effects in breast cancer patients is depression, which affects
the quality of life in these patients. According to the report of Pilevarzadeh
et al., the
global prevalence of depression is 32.2 % among breast cancer patients,
(
6
)
the
management of this complication can improve the quality of life and increase the
survival of cancer patients.
Mirtazapine is an antidepressant drug with serotonergic and noradrenergic effects,
which is used to treat various symptoms of cancer, such as depression, as well as in
the treatment of sleep and appetite disorders.
(7)
In recent years, researchers have
begun to study the antioxidant activity of mirtazapine along with its anti-depressant
effects.
(
8
)
Despite the very low risks of using this drug, some studies report side effects
such as dry mouth, increased appetite, and weight gain.
(
9, 10
)
Considering the roles of
mirtazapine in the management of some psychological disorders such as depression
and its effects on improving the quality of life of patients with breast cancer. This
study aimed to describe the effect of Mirtazapine on improving the quality of life for
cancer patients in
Sabzevar, Iran
.
Methods
This study was conducted as a randomized controlled clinical trial on two groups of
breast cancer patients referred to the chemotherapy and radiotherapy center at
Vasei Educational Hospital of Sabzevar, Iran in 2022. After random assignment, the
research had 55 patients in the intervention group (Mirtazapine) and 55 in the
control group.
Sample size
The sample size was calculated using the formula for the experimental survey.
11
In
this study, random allocation was used. With a margin of error = 0.05 and = 10 %, an
expected power of 90 %, a Z value of 1.28.
Participants were 55 patients
in each group
in
Iran.
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Inclusion criteria: 1- Diagnosis of cancer (both new cases and patients visiting for
follow-up) 2- Not using sleeping pills simultaneously 3- Major depressive disorders
according to DSM IV criteria.
Exclusion criteria: 1- Inaccessibility to the patient due to migration from the area
and... 2- Failure to adhere to a regular treatment plan 3- In case of side effects:
Common: Unusual dreams/anxiety/joint pain and dizziness/sleepiness/dry
mouth/fatigue/insomnia/increased appetite/edema/orthostatic
hypotension/tremor/weigh gain/agitation/anxiety/headache/dizziness/nausea and
vomiting Uncommon: Delusions/mania/syncope/movement disorders/ Rare:
Aggression/pancreatitis/sudden muscle contractions
Uncertain occurrence: Acute angle closure glaucoma/blood
disorders/seizures/dysarthria/hyponatremia/increased salivation/inappropriate
anti-diuretic hormone secretion/sedative effects at the start of treatment/Steven
Johnson syndrome 4- Not taking medication and following the intervention.
Data collection tools:
World Health Organization Quality of Life Questionnaire
(
12
)
Physical Health Subscale: The sum of scores for questions 3, 4, 10, 15, 16, 17, 18 in
the questionnaire. The score range for this subscale will be between 7 and 35, with
a difference of 28.
Mental Health Subscale: The sum of scores for questions 5, 6, 7, 11, 19, 26 in the
questionnaire. The score range for this subscale will be between 6 and 30, with a
difference of 24.
Social Relationships Subscale: The sum of scores for questions 20, 21, and 22 in the
questionnaire. The score range for this subscale will be between 3 and 15, with a
difference of 12.
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Environmental Health Subscale: The sum of scores for questions 8, 9, 12, 13, 14, 23,
24, 25 in the questionnaire. The score range for this subscale will be between 8 and
40, with a difference of 32.
Overall Quality of Life and General Health: The sum of scores for questions 1 and 2
in the questionnaire. The score range for this subscale will be between 2 and 10,
with a difference of 8.
Method for determining the reliability of the tool: This questionnaire was developed
by the World Health Organization and Nazari and colleagues demonstrated the
validity and reliability of the Persian version through a study.
The intervention group received Mirtazapine medication for 8 weeks under the
supervision of a psychiatrist, at a daily dose of 15-30 milligrams. After 8 weeks, all
patients were asked to complete a quality-of-life questionnaire again.
To describe quantitative variables based on conditions, the mean (standard
deviation) was used, and for qualitative variables, frequency report (percentage) was
used. To compare the average quantitative outcomes between two study groups, the
t-test or its non-parametric equivalent, the Mann-Whitney test, was used. To compare
qualitative factors between study groups, the chi-square test or Fisher's exact test was
applied. The data obtained from the study was analyzed using SPSS software version
24, and a significance level of 0.05 was considered.
All participating parents provided informed consent, and the project adhered to the
ethical code: IR.MEDSAB.REC.1399.192. The project was registered under the IRCT
code: IRCT20210425051075NN1.
Results
In this research, 110 cancer patients referred to the Chemotherapy and Radiotherapy
Center in Iran with an average age of 54.05 years and a standard deviation of 12.91
participated. Frequency distribution of education and marital status in two
intervention and control groups using the Chi-square test showed no significant
difference between these two groups in terms of education level and marital status (P
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= 0.897). According to the variables of the study (quality of sleep, life expectancy,
enjoyment of life, satisfaction with sexual relations, and improvement of sad and
hopeless mood and anxiety and depression), the questions of the questionnaire were
divided into 6 groups: the question related to the quality of life (question 1), general
health (question 2), physical health (questions 3, 4, 10, 15, 16, 17, 18), psychological
health (questions 5, 6, 7, 11, 19, 26), social relations (questions 20, 21, 22) and social
environment (8, 9, 12, 13, 14, 23, 24, 25). The results of completing the questionnaires
were analyzed using the Mann-Whitney test and the average variables of the
questionnaires were compared in the intervention and control groups (table 1).
Table1. Comparison of average questionnaire variables in two intervention and
control groups in cancer patients
Variable
Group
N
M
SD
SEM
Quality of life (pre intervention)
Education
55
3.2545
.72567
.09785
control
55
3.2000
.96992
.13078
General health subscale (pre intervention)
Education
55
3.0909
.84487
.11392
control
55
3.8909
4.08100
.55028
Physical health subscale (pre intervention)
Education
55
20.872
7
4.80376
.64774
control
55
20.418
2
4.52847
.61062
Psychology health subscale
(pre intervention)
Education
55
17.636
4
2.69680
.36364
control
55
18.163
6
2.80716
.37852
Social health subscale (pre Intervention)
Education
55
9.4909
1.63155
.22000
control
55
9.2727
1.89985
.25618
Environment health subscale
(pre intervention)
Education
55
27.490
9
4.36685
.58883
control
55
25.127
3
3.46439
.46714
Quality of life subscale (post intervention)
Education
55
3.5273
.57267
.07722
control
55
3.1636
.81112
.10937
General health subscale (post intervention)
Education
55
3.3818
.56078
.07562
control
55
3.3455
.77503
.10451
Physical health subscale (post intervention)
Education
55
22.854
5
3.84138
.51797
control
55
20.145
5
4.31800
.58224
Pshychology health subscale (post intervention)
Education
55
19.872
7
2.25302
.30380
control
55
17.527
3
2.87296
.38739
Social health subscale (post intervention)
Education
55
10.290
9
1.79168
.24159
control
55
9.2000
2.12045
.28592
Environment health subscale (post intervention)
Education
55
27.636
4
4.34768
.58624
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control
55
25.018
2
3.58232
.48304
M= mean SD= estándar desviation SEM= standar error mean
The results of this comparison showed that the average variables in the field of
psychological health before the intervention did not differ significantly between the
two intervention and control groups (P value = 0.317), but after the intervention, it
was significantly different (P <0.001). And the participants of the intervention group
had a higher average. This comparison also showed that the average variables in the
field of physical health were not significantly different between the two groups (p =
0.611), but after the intervention, this difference became relatively significant (p =
0.001). In the field of social relations, the average difference of the study variables
between the two intervention and control groups was not significant before the
intervention (p = 0.520), but after the end of the intervention, it became relatively
significant (p = 0.004). In the field of social environment, before the intervention, the
difference in the average of the variables between the two groups was almost
significant (p value = 0.002) and after the end of the intervention, it became
significant as well (P = 0.001). The comparison of the average variables in the two
groups in the field of quality of life before intervention (p = 0.739) and after (p = 0.008)
has been reported to be significant. Also, this comparison in the field of general health
before (p = 0.157) and after (p = 0.779) intervention between the two research groups
was not significant (table 2).
Table 2.
Independent Samples Test
in two intervention and control groups in
cancer patients
Independent Samples Test
Questionnaire variables
Levene's Test for
Equality of Variances
t-test for Equality of Means
F
p
t
df
Sig.
(2-
tailed)
MD
SED
95% confidence
interval of the
difference
Lower
Upper
Quality of life
(Pre Intervention)
Education
3.732
.056
.334
108
.739
.05455
.16334
-.26922
.37831
Control
.334
100.032
.739
.05455
.16334
-.26951
.37860
General health
Subscale (Pre
Intervention)
Education
1.425
.235
1.424
108
.157
-.80000
.56195
-1.91388
.31388
Control
1.424
58.620
.160
-.80000
.56195
-1.92461
.32461
Physical Subscale
(Pre Intervention)
Education
.195
.660
.511
108
.611
.45455
.89018
-1.30995
2.21904
Control
.511
107.626
.611
.45455
.89018
-1.31002
2.21911
Psychology
Subscale
(Pre Intervention)
Education
.088
.767
1.005
108
.317
-.52727
.52489
-1.56769
.51314
Control
1.005
107.827
.317
-.52727
.52489
-1.56771
.51316
Social Subscale
Education
.305
.582
.646
108
.520
.21818
.33768
-.45115
.88751
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(Pre Intervention)
Control
.646
105.590
.520
.21818
.33768
-.45132
.88769
Environment
Subscale
(Pre Intervention)
Education
3.431
.067
3.145
108
.102
2.36364
.75162
.87379
3.85348
Control
3.145
102.687
.102
2.36364
.75162
.87292
3.85435
Quality of life
(Post Intervention)
Education
1.270
.262
2.716
108
.008
.36364
.13388
.09826
.62902
Control
2.716
97.120
.008
.36364
.13388
.09792
.62935
General health
Subscale
(Post Intervention)
Education
4.794
.031
.282
108
.779
.03636
.12899
-.21932
.29205
Control
.282
98.379
.779
.03636
.12899
-.21961
.29233
Physical Subscale
(Post Intervention)
Education
.814
.369
3.476
108
.001
2.70909
.77929
1.16440
4.25378
Control
3.476
106.556
.001
2.70909
.77929
1.16416
4.25402
Psychology
Subscale
(Post Intervention)
Education
2.476
.119
4.764
108
.000
2.34545
.49230
1.36962
3.32129
Control
4.764
102.192
.000
2.34545
.49230
1.36899
3.32191
Social Subscale
(Post Intervention)
Education
.493
.484
2.914
108
.004
1.09091
.37432
.34894
1.83288
Control
2.914
105.073
.004
1.09091
.37432
.34871
1.83311
Environment
Subscale
(Post Intervention)
Education
3.176
.078
3.447
108
.001
2.61818
.75961
1.11250
4.12386
Control
3.447
104.189
.001
2.61818
.75961
1.11188
4.12448
P<0.05 MD= mean difference SED= standard error difference
Discussion
The results of this research showed that the use of mirtazapine significantly (p < 0.001) improved the
sleep quality of participants in the intervention group. These results are consistent with the findings of
Conkoutaran and colleagues,
(
13
)
who studied the effects of mirtazapine on improving sleep quality and
reducing anxiety and depression symptoms in cancer patients (p < 0.001). Additionally, Kim and
colleagues
(
14
)
conducted a study in 2008 to assess the effectiveness of oral mirtazapine tablets for
nausea and sleep disturbances, common and distressing symptoms of cancer, showing that this
medication improves sleep quality in these patients. These results align with the findings of our
research.
In the field of general health before (p = 0.157) and after (p = 0.779) intervention between the two
research groups was not significant (p > 0.05). These results are consistent with the findings of
Claudia Chaves
15
the “General Health” domain (domain 4) showed a negative correlation with the
CDQ. These results are not consistent with the findings of studies.
(
16-18
)
The results of the study also showed that the use of mirtazapine significantly (p = 0.004) improved
mood, irritability, anxiety, and depression in breast cancer patients.
In 2020, when examining studies
on the impact of mirtazapine on improving the quality of life in cancer patients, it was consistent.
The results of the study by Economus and colleague,
(
19
)
which aimed to evaluate the effectiveness of
mirtazapine in reducing multiple symptoms simultaneously in advanced cancer patients experiencing
a major depressive episode, compared to a group receiving escitalopram, another antidepressant, were
also consistent with the findings of our research. Zaini and colleague
(20)
also conducted a study in 2017
to investigate the effects of mirtazapine on the physical and mental symptoms of cancer patients,
showing that mirtazapine improves the mental symptoms of these patients, including depressive and
anxiety symptoms. Arsoyi and colleagues
(21)
also conducted a study in 2008 to examine the effect of
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mirtazapine on depression symptoms in cancer patients, with the results demonstrating that this
medication significantly impacts the improvement of depressive symptoms in these patients.
The examination of the results of this study showed that the use of the drug mirtazapine somewhat
contributes to improving the satisfaction of cancer patients with their sexual relationships (p = 0.06).
These findings are consistent with the results of the study by Davis and colleagues
(
22
)
in 2002, which
focused on treating quality of life symptoms in cancer patients and demonstrated that mirtazapine
leads to an 11 % improvement in sexual function in these patients, positively affecting their
satisfaction with their sexual relationships.
The results of this research also indicated that the significant use of mirtazapine increases pleasure and
satisfaction in the lives of cancer patients (p < 0.001). These results align with the findings of the study
by Theobald and colleagues,
(23)
which examined the effect of mirtazapine on anxiety symptoms and
quality of life in cancer patients and showed that this drug is effective in improving the quality and
satisfaction of life in these patients.
Conclusion
The results of this study indicated that the use of mirtazapine in cancer patients significantly leads to
improving sleep quality, lifting mood, reducing feelings of hopelessness, anxiety, and depression, as
well as increasing enjoyment of life and its overall quality. In the field of general health intervention
between the two research groups was not significant. Additionally, mirtazapine has positive effects on
increasing the satisfaction of cancer patients with their sexual relationships and enhancing their sexual
function. The results of this study can be beneficial in treating symptoms such as sleep disorders,
sexual dysfunction, mood disturbances, and anxiety symptoms in cancer patients, leading to an
improvement in their quality of life.
The use of a larger and more diverse sample population, including individuals with various types of
cancer, can help better support the results of this study.
Bibliography references
1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer
statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185
countries. CA: a cancer journal for clinicians 2021:71(3): 209-249.
2. Trayes KP, Cokenakes SE. Breast cancer treatment. American Family Physician 2021:104(2): 171-
178.
3. Burguin A, Diorio C, Durocher F. Breast cancer treatments: Updates and new challenges. Journal
of personalized medicine 2021:11(8): 808.
Effect of Mirtazapine Medication on Improving the Quality of Life in Breast Cancer Patients
Rev. Hosp. Psiq. Hab. Volumen 21| No 3| Año 2024 |
Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite el uso,
distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente citada la fuente
primaria de publicación.
4. Alquraan L, Alzoubi KH, Rababa’h S, Karasneh R, Al-Azzam S, Al-Azayzih A. Prevalence of
depression and the quality-of-life of breast cancer patients in Jordan. Journal of Multidisciplinary
Healthcare 2020: 1455-1462.
5. Hashemi S-M, Rafiemanesh H, Aghamohammadi T, Badakhsh M, Amirshahi M, Sari M,
Behnamfar N, Roudini K. Prevalence of anxiety among breast cancer patients: A systematic review
and meta-analysis. Breast Cancer 2020:27(166-178.
6. Pilevarzadeh M, Amirshahi M, Afsargharehbagh R, Rafiemanesh H, Hashemi S-M, Balouchi A.
Global prevalence of depression among breast cancer patients: A systematic review and meta-
analysis. Breast cancer research and treatment 2019:176(519-533.
7. Economos G, Lovell N, Johnston A, Higginson IJ. What is the evidence for mirtazapine in treating
cancer-related symptomatology? A systematic review. Supportive Care in Cancer 2020:28(1597-
1606.
8. de Queiroz Oliveira T, de Sousa CNS, Vasconcelos GS, de Sousa LC, de Oliveira AA, Patrocínio
CFV, da Silva Medeiros I, Júnior JERH, Maes M, Macedo D. Brain antioxidant effect of mirtazapine
and reversal of sedation by its combination with alpha-lipoic acid in a model of depression induced by
corticosterone. Journal of Affective Disorders 2017:219(49-57.
9. Biswas PN, Wilton LV, Shakir SA. The pharmacovigilance of mirtazapine: Results of a
prescription event monitoring study on 13 554 patients in england. Journal of Psychopharmacology
2003:17(1): 121-126.
10. Kraus T, Haack M, Schuld A, Hinze-Selch D, Koethe D, Pollmächer T. Body weight, the tumor
necrosis factor system, and leptin production during treatment with mirtazapine or venlafaxine.
Pharmacopsychiatry 2002:35(06): 220-225.
11. White H, Sabarwal S. Quasi-experimental design and methods. Methodological briefs: impact
evaluation 2014:8(2014): 1-16.
12. de Souza CCC, Zacarias LC, Campos NG, Fortaleza SCB, Madeira CA, Sousa Almondes JGd,
Leite CF. Validation of the world health organization disability assessment schedule (whodas 2.0) for
individuals with asthma. Disability and Rehabilitation 2024: 1-8.
13. Cankurtaran ES, Ozalp E, Soygur H, Akbiyik DI, Turhan L, Alkis N. Mirtazapine improves sleep
and lowers anxiety and depression in cancer patients: Superiority over imipramine. Supportive care in
cancer 2008:16(11): 1291-1298.
14. Kim S-W, Shin I-S, Kim J-M, Kim Y-C, Kim K-S, Kim K-M, Yang S-J, Yoon J-S. Effectiveness
of mirtazapine for nausea and insomnia in cancer patients with depression. Psychiatry and clinical
neurosciences 2008:62(1): 75-83.
Effect of Mirtazapine Medication on Improving the Quality of Life in Breast Cancer Patients
Rev. Hosp. Psiq. Hab. Volumen 21| No 3| Año 2024 |
Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite el uso,
distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente citada la fuente
primaria de publicación.
15. Chaves C, Zandonadi RP, Raposo A, Nakano EY, Ramos F, Farage P, Teixeira-Lemos E. Health-
related quality of life among celiacs in Portugal: A comparison between general and specific
questionnaires.
Frontiers in Immunology 2024:15(3): 1-9.
16. Calvo‐Torres J, Rejas‐Gutiérrez J, Ramírez‐Mena M, Bradbury M, Del Pino M, González‐
Granados C, Procas B, Coronado PJ, group HQs.
Population‐based norms for the human
papillomavirus‐quality of life (hpv‐qol) questionnaire: A cross‐sectional multicenter study. Acta
Obstetricia et Gynecologica Scandinavica 2024.
17. Coronado PJ, González-Granados C, Ramírez-Mena M, Calvo J, Fasero M, Bellón M, García-
Santos JF, Rejas-Gutiérrez J. Development and psychometric properties of the human
papillomavirus-quality of life (hpv-qol) questionnaire to assess the impact of hpv on women health-
related-quality-of-life. Archives of Gynecology and Obstetrics 2022:306(4): 1085-1100.
18. Taavela K, Eriksson T, Huhtala H, Bly A, Harjula K, Heikkilä K, Hokkanen M, Nummela M,
Kotaniemi-Talonen L, Lehtinen M. The quality of life of frequently vs. Infrequently screened hpv
vaccinated women. Quality of Life Research 2024:33(4): 941-949.
19. Economos G, Alexandre M, Perceau-Chambard E, Villeneuve L, Subtil F, Haesebaert J, Glehen
O. What is the effectiveness and safety of mirtazapine versus escitalopram in alleviating cancer-
associated poly-symptomatology (the mir-p study)? A mixed-method randomized controlled trial
protocol. BMC Palliative Care 2022:21(1): 1-9.
20. Zaini S, Ng C, Sulaiman AH, Huri N, Shamsudin SH. A review of the use of mirtazapine in cancer
patients. Malaysian Journal of Psychiatry 2017:25(2): 58-68.
21. Ersoy MA, Noyan AM, Elbi H. An open-label long-term naturalistic study of mirtazapine
treatment for depression in cancer patients. Clinical drug investigation 2008:28(2): 113-120.
22. Davis MP, Khawam E, Pozuelo L, Lagman R. Management of symptons associated with
advanced cancer: Olanzapine and mirtazapine. Expert review of anticancer therapy 2002:2(4): 365-
376.
23. Theobald DE, Kirsh KL, Holtsclaw E, Donaghy K, Passik SD. An open-label, crossover trial of
mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. Journal of
pain and symptom management 2002:23(5): 442-447.
Ethics approval
Ethical approvals in this study, all procedures performed on human samples were conducted
following the relevant guidelines and regulations of the Helsinki Declaration. The study protocol was
approved by the Research Ethics Committee (
IR.MEDSAB.REC.1399.192
) in Sabzevar Iran.
Effect of Mirtazapine Medication on Improving the Quality of Life in Breast Cancer Patients
Rev. Hosp. Psiq. Hab. Volumen 21| No 3| Año 2024 |
Este material es publicado según los términos de la Licencia Creative Commons Atribución–NoComercial 4.0. Se permite el uso,
distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente citada la fuente
primaria de publicación.
Availability of data and material
The datasets used and/or analyzed during the current study are available from the corresponding
authors on reasonable request.
Conflict of Interest disclosure:
The authors declare that there are not conflicts of interest
Funding
Not applicable
Authors' contributions
All authors read and approved the manuscript.
Acknowledgements:
The authors would like to thank all the participants who kindly cooperated in the process of the study.
We also want to thank the Deputy of Research and Technology of
Sabzevar University of Medical
Sciences, Sabzevar, Iran.