• CAPS score improvement [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
  

• Side effect assessments [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
  

After meeting inclusion criteria, the patients enter an 8-week randomized, double-blind, placebo-controlled treatment trial of mirtazapine. After completion of the placebo-controlled phase, patients may continue study participation in an open-label mirtazapine for an additional 8 weeks.

The VA Pharmacy has an established working relationship with the investigators. The pharmacist maintains the randomization log and verifies the order for the placebo or mirtazapine (15mg) in look-a-like capsules. The investigators and patients are kept blind to the contents of the capsules until the end of the entire study. See procedure grid in attached Work Proposed Section attached. Based on symptomology and occurrence of side effects, the investigator increases the medication in 15 mg (one capsule) increments every week, as tolerated, until a maximum therapeutic benefit is achieved, not to exceed 45 mg/day (3 capsules). The dosing is at bedtime. Compliance is assessed by biweekly pill count. Patients are given supportive clinical management during the clinic visits. An investigator is available by telephone 24 hrs a day in case of emergency. Patients may be seen more often if needed. At the end of the placebo-controlled phase, if the patients agree to continue in the study (confirmed at every visit) and they have not experienced an intolerable side effect related to the study medication, the patient will stop the placebo-controlled medication and begin open label mirtazapine, starting with 15mg at bedtime and titrating as tolerated to a maximum of 60mg/day.