Mirtazapine (Remeron) in Mental Health Treatment: What It Is and How It Works

Author:

Jemma Strain

B.S. Psychology

Editor:

Emma Loker

B.S

When mental health issues such as depression affect your ability to live a full life, your main concern may be to try and return to your status quo. But what if you’ve tried antidepressants and they haven’t worked – or even made your symptoms worse?

Different classes of antidepressants have varying emotional and physical effects, meaning that what works for one person may not have the same benefits for another. If first-line medications didn’t give you the results you wanted, your provider may discuss the option of an atypical antidepressant called “mirtazapine” (Remeron).

But what is mirtazapine? And how can it work for you? Mission Connection can help you understand whether mirtazapine is right for your needs, but this article also works as a useful guide, discussing…

What mirtazapine is and how it works
The conditions mirtazapine is prescribed for
How long it takes mirtazapine to work
Mirtazapine dosage guidelines
Potential mirtazapine side effects
How to stop mirtazapine safely
Answers to frequently asked questions about mirtazapine
Where to find professional mental health and medication guidance

What Is Mirtazapine?

Mirtazapine, also known by the brand name “Remeron,” is an atypical tetracyclic antidepressant that is most commonly prescribed to treat moderate to severe symptoms of major depression. It first came to light in the 1980s, but was approved for treating depression by the Food and Drug Administration (FDA) in 1996.¹

While mirtazapine is FDA approved for depression, it’s also prescribed off-label for conditions such as…¹

Panic disorder
Post-traumatic stress disorder (PTSD)
Generalized anxiety disorder
Social anxiety disorder
Obsessive-compulsive disorder (OCD)
Insomnia
Migraines

Off-label prescribing is commonplace, as providers might determine that a medication could work for people who don’t respond well to other treatments or in situations where no alternative options exist.

Experts aren’t entirely sure how mirtazapine works to improve the symptoms of mental health conditions, but they do know that it increases the amount of mood-improving chemicals in the brain. Yet, as an atypical antidepressant, it works differently from regular antidepressants. Typical antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclics, usually target the chemicals serotonin and norepinephrine. In contrast, mirtazapine increases serotonin and noradrenaline in the brain. This means that it may produce different benefits and side effects than other antidepressants.²

As mirtazapine’s effects differ from other medications, it may be suitable for people whose symptoms haven’t responded to previous treatments or for conditions that have no alternative treatment options.

However, mirtazapine usually isn’t considered a first-line treatment for conditions such as depression. Typically, second-generation antidepressants are the “go-to” options for providers, as they tend to reduce symptoms while producing limited side effects. Your provider can talk to you or a loved one about whether mirtazapine could be suitable for your needs.

What Is Mirtazapine Used for?

Mirtazapine is primarily used to treat depression. Studies have shown that it’s not only superior to a placebo in treating depressive symptoms, but also at least as effective as a range of other antidepressants, including amitriptyline, fluoxetine, and trazodone.^3,4As mentioned, mirtazapine can also be used off-label to treat a variety of other conditions.

Yet, due to the medication’s potential physical and emotional side effects, many providers consider it to be a second- or third-line treatment. However, it may be an effective alternative for people who experience sexual side effects or sleep problems from other medications, such as SSRIs and SNRIs.⁵

The following information covers some of the conditions for which mirtazapine is sometimes prescribed off-label.

Mirtazapine for Anxiety and Sleep

Anxiety is a common mental health condition that affects up to one in five adults in the U.S.⁶ Although mirtazapine is an antidepressant, it’s also sometimes used to treat anxiety, especially generalized anxiety disorder (GAD). Studies have shown that mirtazapine works well to reduce anxiety symptoms in GAD and tends to be well tolerated.⁷

Also, while mirtazapine isn’t a sleeping tablet, it has been shown to help sleep disturbances, as it can cause sedation. This effect may work best when sleep issues go hand in hand with issues like depression and anxiety.⁸

Remeron for Elderly Depression

The use of certain antidepressants in later life can create a variety of issues, including raising the risk of dementia, diabetes, accidents, gastrointestinal bleeding, and so on.⁹ As mirtazapine works differently from other antidepressants, it may also result in different side effects in later life. For instance, studies show that mirtazapine can produce positive results in late-onset depression, including benefits for sleep and appetite.¹⁰

Aside from depression, anxiety, and sleep issues, mirtazapine can be prescribed for chronic migraines. For instance, it can be started at low doses to help migraines from occurring, and the dose can be increased until positive results are achieved.¹¹

How Long Does Remeron Take to Work?

How long Remeron takes to work can vary from person to person. Mirtazapine isn’t a short-acting drug, so it takes time for the chemicals in the brain to produce positive changes. Therefore, the rate at which someone sees these changes can differ. For instance, some people might see a reduction in symptoms at the one to two week mark, but in general, it can take up to eight weeks for the medication’s full onset to kick in.

When it takes nearly two months to see benefits, some people may become discouraged. However, the early effects of antidepressants can be subtle, so we highlight these below.

Signs Remeron Is Working:

Better sleep
Improved appetite
Boost in energy levels
Reduced feelings of hopelessness and irritability
Less anxiety and sadness
A greater sense of self

The former of these signs may be the first ones you notice, but they can give some hope as they’re an indicator that physical changes in the brain are happening. If you don’t notice any signs that Remeron is working, speak to your provider about your concerns. They may be able to up your dose or trial a different medication.

Mirtazapine Dosage Guide

The mirtazapine dosage can depend on factors like age, weight, symptoms, and the condition being treated. However, as a general rule of thumb, providers typically start people on the lowest dose recommended for a condition. This way, they can slowly increase the dose to achieve benefits while managing the risk of side effects.

As mirtazapine is only FDA-approved for depression, there are only dosage guidelines available for this condition. If you’re interested in mirtazapine for off-label purposes, your provider can discuss the best dosage recommendations for your needs.

The following are the mirtazapine dosage guidelines for depression.¹²

Starting dose: 15 mg orally once a day at bedtime
Maintenance dose: 15-45 mg orally once a day
Maximum dose: 45 mg orally once a day

A provider will monitor patient reactions to different doses, potentially increasing the dose over a number of weeks as long as side effects are under control.

Potential Remeron Side Effects

Like all other antidepressants, Remeron comes with its share of side effects. However, these side effects can differ from other forms of antidepressants, often making it suitable for people who don’t react well to different treatments. Not everyone will experience mirtazapine side effects, and those who do often transition past them after a couple of weeks. However, if the following symptoms become too uncomfortable or persist past the period of adjustment, speak to your provider about your concerns.

Common Mirtazapine Side Effects:¹³

Anxiety
Sedation
Dizziness
Confusion
Increase in appetite and weight
Nausea
Vomiting
Constipation
Dry mouth
Increased cholesterol levels

While these side effects typically pass, mirtazapine also comes with some less common but more serious risks. These include…

Chest pain
Rapid heartbeat
Eye pain or vision changes
Seizures

If you notice any of these symptoms, it’s important to seek medical assistance as soon as possible.

Is Stopping Remeron Suddenly a Good Idea?

It’s never a good idea to stop Remeron suddenly. Like other antidepressants, mirtazapine works by altering the levels of neurotransmitters in the brain, so it takes time for the body to adjust to lower levels of these chemicals. Abruptly stopping Remeron can cause a return of mental health symptoms and mirtazapine withdrawal symptoms. These withdrawal symptoms can be highly uncomfortable and even last for weeks.

Additionally, withdrawal symptoms, such as the following, can be physical or mental. If you notice any of these, it’s important to contact your provider. Also, if you miss a dose of mirtazapine, take the dose as soon as possible – but if it’s time for your next dose, don’t double up. Just continue your dosage as normal.

Mirtazapine Withdrawal Symptoms:¹⁴

Nausea
Vomiting
Diarrhoea
Headaches
Dizziness
Tremors
Balance issues
Sleep problems
Anxiety
Irritability
Rapid changes in mood
Confusion
Concentration and focus difficulties

Tapering Off Mirtazapine Safely

To avoid relapsing into mental health symptoms and uncomfortable withdrawal symptoms, it’s important to taper off mirtazapine slowly and under professional guidance.

Healthcare providers can help you create a tapering plan that considers the length of time you’ve been on the medication, your dosage, and the reason you went on the medication in the first place. This way, they can manage any negative effects caused by stopping Remeron. For instance, they may reduce your dose gradually over the space of weeks and months, monitoring your emotional and physical responses throughout the process.

Mission Connection can work with you to create a tapering plan that takes your needs into account.

Frequently Asked Questions About Mirtazapine

As mirtazapine is an atypical antidepressant, you may still have questions about how it works in comparison to other medications and whether its side effects will create problems for treatment. This is normal – it can be difficult to find all the answers to your questions in one place.

For this reason, we’ve provided responses to some FAQs below. If you still have concerns about whether mirtazapine is right for you, your provider will be more than happy to discuss whether it’s a good fit for your needs.

Does Mirtazapine Cause Weight Gain?

Unfortunately, one of the side effects of mirtazapine is increased appetite and weight gain. While a boost in appetite can benefit people who lose weight due to their mental health issues, it can create a problem for others. For instance, the medication can lower self-esteem and raise the risk of cardiovascular issues, diabetes, and metabolic concerns.¹⁵ If you’re worried about weight gain on mirtazapine, it’s best to talk openly with your provider. They may help you create healthy nutrition and lifestyle plans, or switch you to an atypical antidepressant which isn’t linked to weight gain, such as bupropion.

Does Mirtazapine for Insomnia Work?

Mirtazapine has a sedative effect, so it may help some people with insomnia drift off more easily. Some doctors may even prescribe Remeron for insomnia without depressive symptoms – but this isn’t generally recommended.¹⁶ But, in a nutshell, as over 50% of people who take mirtazapine report increased sedation, it could work for treating insomnia.¹⁷ For this reason, it’s best to take the medication before bedtime to improve sleep quality.

Which Is Right For Me? Mirtazapine vs Trazodone

When it comes to mirtazapine vs trazodone, the right medication for you will come down to your symptoms, response to medication, and needs. For instance, studies have shown that people tend to respond to and tolerate mirtazapine better.¹⁸ However, the side effects of both drugs vary, with weight gain being more common with mirtazapine than trazodone. Ultimately, your condition and response to side effects will determine which medication is the best fit for you.

Can Remeron Cause Nightmares?

Mirtazapine has a sedative effect, meaning that it can suppress REM sleep. As most dreams and nightmares tend to happen during this deep sleep phase, Remeron is not typically linked to nightmares. In fact, other atypical antidepressants, such as bupropion, may increase REM sleep, so they may be more associated with nightmares.¹⁹

Mission Connection: Covering All Aspects of Mental Health Care

When the topic of medication for mental health needs arises, it can cause a lot of questions and concerns to bubble up – let alone when the medication is an atypical antidepressant. Atypical antidepressants, such as mirtazapine, work differently from drugs that are considered the “go-to” for mental health treatment, so they carry their own set of benefits and side effects.

Mission Connection can help you better understand the role of mirtazapine in your mental health plan, including whether it’s the right fit for your needs. Our team also highlights the importance of looking beyond symptoms to the root causes of problems, offering long-term solutions.

Our therapy packages are tailored to each person’s unique needs, including medication management, residential care, outpatient options, and telehealth services. In other words, whatever your needs, Mission Connection can meet you where you are.

If you’re ready to talk or just have more questions about the services we offer, our team is always available. Reach out to us to start the next step in your healthcare journey.

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