Sustained Remission in a Patient With Depression, Chronic Insomnia, and Ischemic Heart Disease Using a Combination of Agomelatine and Mirtazapine: A Case Report

Agomelatine and mirtazapine are antidepressants with complementary pharmacological profiles. However, this combination is rarely reported in clinical practice. We report a case of a 54-year-old man with ischemic heart disease, diabetes, and hypothyroidism, who achieved early full remission of major depressive disorder and chronic insomnia following treatment with agomelatine and mirtazapine. By the four-week follow-up, the patient reported sleeping 8-9 hours/night with normalized mood and cognitive function. He sustained full remission for over three months, with no adverse effects. Serial lab investigations and ECGs remained stable throughout. No arrhythmic events or QTc prolongation were observed during follow-up. While not commonly reported together in routine care, the combination was well tolerated and appeared to support both mood improvement and sleep restoration, without notable side effects, despite the presence of multiple cardiovascular and metabolic comorbidities. This case adds to the expanding literature and suggests that this combination may be a useful off-label option for select patients with depression and insomnia who are at risk of cardiovascular or metabolic complications.