Only a small minority of people with fibromyalgia enjoy benefit from mirtazapine

Any potential benefits of mirtazapine in fibromyalgia are outweighed by its potential harms, says a new Cochrane Review of the evidence. However, a small minority of people with fibromyalgia might experience relief from symptoms without clinically-relevant side effects.
The aim of drug therapy for people with fibromyalgia is to reduce key symptoms and improve quality of life. It is thought that an antidepressant called mirtazapine may help by increasing levels of certain neurotransmitters in the brain.
Now a review of the evidence has found three studies involving 606 people that compared mirtazapine with placebo over seven to 13 weeks. Taken together, the studies demonstrated no benefit of mirtazapine over placebo for pain relief of 50% or greater, Patient Global Impression of Change, improvement of health related quality of life of 20% or greater, or reduction of fatigue or negative mood.
Sleepiness, weight gain, and elevated alanine aminotransferase (measure liver function) were more frequent with mirtazapine than placebo.
However, clinically-relevant benefits were shown for pain relief of 30% or greater, reduction of average pain intensity and sleep problems.
But the quality of evidence was low or very low so more research is needed before firm conclusions can be made. The authors summarise:
“On balance, any potential benefits of mirtazapine in fibromyalgia were outweighed by its potential harms, though, a small minority of people with fibromyalgia might experience substantial symptom relief without clinically-relevant adverse events.”

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