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Remeron (mirtazapine) is an atypical antidepressant used to treat major depressive disorder. It can also be used off-label to treat anxiety disorders and insomnia due to its range of effects. Mirtazapine should be taken exactly as prescribed, as it can cause adverse effects if misused.
- Remeron (mirtazapine) is an antidepressant medication, classified as an atypical antidepressant, and it is used as a second-line treatment for major depressive disorder.
- Remeron might be prescribed to treat other conditions, including anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, or insomnia.
- Remeron should be taken exactly as prescribed by a doctor and should not be misused as it can cause adverse effects.
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Remeron (mirtazapine) standard dosage guidelines
Remeron is a brand name medication containing mirtazapine. Mirtazapine is a tetracyclic atypical antidepressant, meaning that its mechanism of action is very different from other traditional antidepressants.
Remeron is approved by the Food and Drug Administration (FDA) to treat major depressive disorder (MDD). It is also used off-label for uses that are not FDA-approved, including anxiety disorders and sleep disorders. [1]
Typically, mirtazapine is prescribed after a trial of selective serotonin reuptake inhibitors (SSRIs) has been ineffective at managing symptoms of depression. Mirtazapine can be particularly helpful if the individual has coexisting symptoms of insomnia or decreased appetite, due to its sedating and appetite-stimulating effects. [1]
When prescribed mirtazapine for depression, the dosage will likely be increased gradually to reduce the risk of adverse effects. The starting dose is usually 15 mg per day, often taken at night due to sedative effects. The dosage can be increased gradually up to 45 mg per day. Treatment can continue for several months or years, depending on the individual. [2]
If treatment is to be discontinued, the prescribing doctor will make gradual reductions to the daily dosage in order to reduce the risk of withdrawal symptoms or discontinuation syndrome. This can include unusual sensations, sudden changes in mood, restlessness, decreased appetite, nausea, and sleep disturbances. [2]
Mirtazapine for anxiety disorders
Mirtazapine is sometimes prescribed off-label for anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. [3]
Studies show that mirtazapine can be effective at managing symptoms of anxiety. An effective dose of mirtazapine for anxiety disorders might be 30 mg per day. [4][5]
Mirtazapine’s efficacy in treating anxiety disorders results from its actions on the neurotransmitters serotonin and noradrenaline, which impact mood and energy regulation, and as a result of its calming or sedating effects. [1]
Mirtazapine for insomnia and sleep disorders
Mirtazapine has a strong sedative effect, which can help manage insomnia and other sleep disorders. It has been shown to be an effective treatment for insomnia, usually in doses of 7.5 mg to 30 mg taken once per day at bedtime.[6]
Remeron dosage forms and strengths
Remeron is available as a tablet and orally disintegrating tablet (SolTab). Each form is available in 15 mg, 30 mg, and 45 mg strengths.[2][7]
The tablet should be swallowed whole without crushing. The disintegrating tablet should be placed on the tongue, where it will disintegrate and can be swallowed with saliva.
Maximum dosages
It is not recommended to take doses of mirtazapine higher than 45 mg per day. Higher doses are not shown to have any additional therapeutic benefit and may increase the risk of adverse effects.[2]
Mirtazapine side effects
It is common to experience side effects when starting a new medication or changing doses. Side effects are common when starting Remeron treatment, which will often be alleviated within a couple of weeks. If side effects persist or become problematic, contact a doctor for advice.
Common side effects of mirtazapine include: [2][8]
- Dizziness
- Drowsiness
- Nausea
- Vomiting
- Constipation
- Increased appetite and weight
- Anxiety
- Dry mouth
- Unusual dreams
Serious side effects of Remeron can occur, which should be reported to a doctor immediately: [2][8]
- Flu-like symptoms
- Signs of infection
- Fever
- Rapid heartbeat
- Chest pain
- Seizures
Precautions
Precautions when using mirtazapine treatment include: [2]
- Serotonin syndrome: Serotonergic medications, such as mirtazapine, can increase the risk of serotonin syndrome, a potentially fatal condition of excessive serotonin levels in the body. Symptoms include fever, severe hypertension, changes in mental status, confusion, agitation, delirium, and coma. This risk is increased if mirtazapine is combined with other serotonergic medications.
- Discontinuation: When stopping mirtazapine treatment, doses should be reduced gradually in order to prevent discontinuation syndrome. This can cause symptoms such as sensory disturbances, electric-shock sensations, anxiety, headache, nausea, vomiting, confusion, and fatigue.
- Drowsiness: Mirtazapine can cause drowsiness. As such, it is advised not to drive a car, operate heavy machinery, or engage in activities requiring alertness until assessing how the medication affects motor performance.
- Weight and appetite: Mirtazapine can cause increased appetite and weight gain. People may wish to consult with their doctor about how to manage this if they are concerned about weight gain.
- Mania: Antidepressants can precipitate a manic or hypomanic episode. People should be screened for symptoms of bipolar disorder or mania before commencing treatment.
- Seizures: There is some risk of seizures due to mirtazapine use. People with a history of seizures should be monitored carefully when starting mirtazapine treatment.
- Illness: People with heart, liver, or kidney conditions should consult their doctor before commencing treatment, as they may require a reduced dose or careful monitoring.
- Suicide risk: Antidepressants can cause a risk of suicidal thoughts, particularly at the start of treatment. If suicidal thoughts occur, or if family members notice concerning behaviors, this should be reported to the prescribing doctor for monitoring or treatment.
- Pregnancy or breastfeeding: There may be some risk to the fetus or infant if taking mirtazapine while pregnant or breastfeeding. However, it is important to discuss this with a doctor, as the benefits of treatment may outweigh the potential risks.
- Glaucoma: Mirtazapine can increase the risk of glaucoma. It may be necessary to undertake an eye examination before or during treatment, and effects such as eye pain, vision changes, or eye redness should be reported to a doctor immediately.
Mirtazapine abuse potential
Mirtazapine is not considered a drug of abuse and is unlikely to cause addictive or drug-seeking behaviors. However, physical tolerance can develop with prolonged mirtazapine use, which may increase the risk of misuse. Additionally, mirtazapine can interact with other drugs and might be misused alongside other drugs for these effects. [2]
Potential drug interactions
Mirtazapine should not be combined with monoamine oxidase inhibitors (MAOIs), which represent another type of antidepressant. This combination could cause serotonin syndrome, which can be serious or fatal. It is advised to ensure there is at least 14 days between doses of mirtazapine and MAOIs if changing treatments. Other antidepressants and serotonergic medications can also increase the risk of serotonin syndrome if used in combination with mirtazapine. [2]
Mirtazapine can interact with other drugs and medications, which may reduce the effectiveness of the medication or cause adverse effects. This includes alcohol, anti-seizure medications, antifungals, other antidepressants, blood-thinning medications, mood stabilizers, and benzodiazepines. [1][8]
It is important to discuss all medications with the prescribing doctor before starting a new treatment.
Mirtazapine overdose
Taking a large dose of mirtazapine can result in overdose. Symptoms of a mirtazapine overdose can include: [2][8]
- Drowsiness
- Changes in heartbeat
- Confusion
- Memory impairment
- Seizure
- Breathing difficulties
- Loss of consciousness
The risks of a mirtazapine overdose may be increased if taken with other substances.
If a mirtazapine overdose is suspected, call poison control at 1-800-222-1222. In case of an emergency, such as if the individual is unconscious, is struggling to breathe, or has a seizure, call 911 immediately.
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