Study of Indoleamine 2,3-dioxygenase Activity, Serum Levels of Cytokines, BDNF, BH4 and Mirtazapine Efficacy in Fibromyalgia Syndrome

Exclusion Criteria

• •any severe or unstable physical or psychiatric disorder
• •inflammation or injury or trauma in the previous month
• •substance abuse within the past year
• •serious suicide risk
• •pregnancy or breastfeeding
• •subject has an allergic reactions to mirtazapine or any of its constituents or severe allergic reactions to multiple medications
• •comorbid inflammatory rheumatic diseases
• •Use of medications or herbal agents with CNS activity
• •regular use of analgesics with the exception of acetaminophen up to 2 gram/day
• •chronic use of sedatives/hypnotics
• •unable to discontinue medications that may affect the study results (all antidepressants, mood stabilizers, antipsychotics, sleep aids such as hypnotics, tranquilizers, sedating antihistamine and benzodiazepines, all analgesics including anticonvulsants, muscle relaxants, stimulant medications such as dextroamphetamine and methylphenidate, any other medications taken by the subject for the treatment of fibromyalgia
• •unable to attend the follow-up schedule of the study
• •not agree with avoidance or stable maintenance of unconventionalor alternative therapies, such as Thai traditional massage