Remeron (Mirtazapine)

Understanding Remeron (Mirtazapine)

Mirtazapine, sold under the brand name Remeron, is a tetracyclic antidepressant (TCAs), a class of prescription antidepressants. Remeron is occasionally used to treat mental health issues such as generalized anxiety disorder, social anxiety, and obsessive-compulsive disorder but is used predominantly in the treatment of Major Depressive Disorder (MDD). 

Remeron comes in a tablet form of 7.5, 15, 30, and 45 mg that is to be taken daily, preferably before sleep, and is normally only prescribed for a maximum of 40 weeks. Remeron works by enhancing the activity of neurotransmitters called noradrenaline and serotonin in the brain.^[1] These neurotransmitters act as messengers between nerve cells and are responsible for releasing mood-enhancing chemicals such as serotonin and noradrenaline.

Effects of Remeron abuse

For those who take Remeron in the prescribed dosage, the drug can improve mood, well-being, sleep patterns, and appetite as well as decreasing overall nervousness. For some, it can have negative and harmful side effects, especially when abused by taking in higher doses than prescribed or for long periods of time.^[2] These side effects include both physical and psychological reactions such as:

• Weight gain
• Drowsiness
• Abdominal pain
• High cholesterol
• Dry mouth
• Constipation
• Vomiting
• Diarrhea
• Body aches
• Trouble concentrating
• Strange dreams

There are reported cases of people experiencing more severe side effects from Remeron. ^[2] These include suicidal ideation, manic behavior, depersonalization, and increased depression. The latter has been documented predominantly in those suffering from MDD and can result in a worsening of depression and increased suicidal thoughts in both adult and child patients. 

Remeron can also cause a severe condition called serotonin syndrome, whereby the brain overproduces serotonin causing mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity. ^[3] Serotonin syndrome can occur in those who are only taking Remeron but is most common in those who also take the drug alongside other antidepressants, especially monoamine oxidase inhibitors (MAOIs). 

As well as increased risk of severe side effects when abusing Remeron with other antidepressants, they are also far more likely to occur when abused with other substances such as alcohol or stimulants. Remeron doesn’t produce a euphoric high on its own and is typically abused for its relaxing and mood-enhancing effects. Those who abuse the substance will also do so alongside other substance abuse to increase the effects of both. This can lead to the more severe side effects of Remeron abuse presenting themselves, such as panic attacks, convulsions, cognitive impairment, abdominal pain, and erratic behavior.

Signs of Remeron abuse

While antidepressants like Remeron are generally considered to be non-addictive, there is still the possibility of a dependence forming if abused regularly or in large doses. According to the 2018 National Survey on Drug Use and Health (NSDUH), an estimated 16.9 million Americans (6.2 percent of the population) aged 12 or older misused prescription psychotherapeutic drugs like Mirtazapine at least once in the past year. ^[4]

Remeron also has adverse withdrawal symptoms that can develop even if a person takes the recommended dosage and stops. This can lead to people continuing to abuse the substance in order to avoid withdrawal symptoms, which in turn can build up a tolerance to the substance, create a physical dependence, and ultimately addiction when the negative consequences of dependence accumulate.  

As antidepressants like Remeron have become prevalent in today's society, and because the negative indicators of abuse may be indistinguishable at first from the positive benefits the drug can have for those suffering from mental health disorders, it is not always easy to spot the signs of misuse. Here are some signs that someone may be abusing Remeron:

• Taking the drug longer than prescribed
• Needing more and more of the drug to elicit the same effects
• Being unable to stop using despite negative effects
• Faking symptoms to get Remeron prescriptions
• Sudden changes in physical appearance, hygiene, and behavior

There is also the risk of Remeron overdose when the drug is abused in high doses or alongside other central nervous system depressants such as alcohol. Signs of Remeron overdose include low blood pressure, chest pain, hallucinations, vomiting, slurred speech, and trouble breathing. Remeron overdose can be fatal as it can cause severe respiratory complications. ^[5]

Remeron withdrawal, detox, and treatment

Stopping Remeron abuse suddenly or going cold turkey can cause uncomfortable withdrawal symptoms, which can often cause those attempting to quit Remeron abuse to relapse. The withdrawal symptoms from Remeron include nausea, vomiting, irritability, rebound depression/anxiety, pins and needles, dizziness, and bad nightmares. As these withdrawal symptoms can be physically and mentally taxing on those with addiction, it is always advised that a person who abuses Remeron attends a medically supervised detox.  

Detoxing in an addiction treatment facility can ensure that the patient goes through the detox process safely and comfortably, and greatly increases the chances of full recovery. Withdrawal symptoms (even if assisted by a medical detox) can last for a couple of weeks and in some cases months. For the best chances for successful sobriety, those addicted to antidepressants like Remeron should attend an inpatient or outpatient rehab facility. These treatment centers will offer a detox program followed by a full course of rehabilitation practices including behavioral therapy and medical treatment to manage cravings and withdrawal. 

If you or someone you know is suffering from Remeron addiction, contact a treatment center today to see what help is available.