CFRD / frequently decreased BMI in CF / Mitrazapin for off-label use?

Question

Due to the stress reaction of the body of a patient with CF because of a permanent inflammatory reaction underweight is developing frequently in the course of time. Besides the probable increase of respiratory work and the probable decrease of secretion and activity of pancreatic enzymes the reason for that development of underweight is probably mainly the increased cortisole production and the resulting insulin resistance (among others).
What would you think about the proposal to try an off-label use of Mitrazapin (e.g. Remergil) in patients over 16 years of age and with a pathologic cortisole level (would say increased level); a drug which is a secure and effective anti-depressive drug with mild and transient side-effects? The most frequently shown side-effect is weight-gain which is caused probably on the one hand by a decrease of the cortisole level and on the other hand by a blockage of the 5-HT2-receptor, which leads to an increase in appetite.
The anti-depressive side-effect is not necessarily unwanted. An additional argument for a try of this drug could be a massive impairment of the sleep as a main symptom of a depression.
A study about Mitrazapin for the use in anorexia nervosa can be found here: http://edoc.ub.uni-muenchen.de/5458/. In this study the influence of Mitrazapin on the cortisole level in the saliva has been investigated and additionally the weight-gaining effect could be shown impressively (however, probably this effect had also other reasons in the frame of this study). On a website (http://www.sanego.de/Medikament_Mirtazapin) asking systematically for subjective side-effects of drugs 83 comments out of 148 (would say 53%) mention a weight gain.
The partly awkward BMI-situations in CF would absolutely justify this procedure in my opinion. Is it not possible to initiate a study on that topic?
Yours sincerely,

Answer

Hello,
unfortunately the question returned now from the first expert (no experience...), therefore I would like to write quickly my own view on that topic, in order not to let you wait any longer.
In fact one has also to be willing to take unusual ways, if the aim could not be achieved by the normal way. There is few literature on that topic in CF, at the moment I do not have access to the original work, therefore I have to get it first. I will contact you as soon as I can get more concrete.
Yours sincerely and best wishes for the new year.

17.03.2008