Mirtazapine



Mirtazapine 783
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Definition

Mirtazapine is most commonly used to treat depression. Mirtazapine is available in the United States under the trade names of Remeron and Remeron SolTab.

Mirtazapine, sold under the trade name Remeron, is taken by mouth and swallowed whole. Remeron SolTabs should be allowed to dissolve in the mouth. No water is needed when taking the SolTabs, since these tablets disintegrate in saliva and are not swallowed whole.

Purpose

Mirtazapine is best known for treating depression. However, it may also be used for treating anxiety or to make people drowsy just before surgery.

Description

Mirtazapine is usually thought of as an antidepressant, or a drug that alleviates symptoms of depression. Approved by the Federal Drug Administration (FDA) in 1996, it is believed to alter the activities of some chemicals in the brain and, in this way, reduce chemical imbalances responsible for causing depression and anxiety. As with all antidepressants, it may take several weeks of treatment before full beneficial effects are seen. Mirtazapine is broken down by the liver and eliminated from the body mostly by the kidneys. It is supplied in 15-, 30-, and 45-mg tablets.

Recommended dosage

The recommended initial dose of mirtazapine in 15 mg taken at bedtime. The dose may be increased in 15-mg increments every one or two weeks as needed until symptoms of depression or anxiety resolve. Typical doses range between 15 and 45 mg. Dosages above 45 mg per day are not recommended. Elderly people or those with liver or kidney disease should use mirtazapine carefully, since they may be more sensitive to some of the drug's side effects.

Precautions

Mirtazapine may cause weight gain and may increase cholesterol levels and should be used carefully in overweight individuals and those with high cholesterol levels. If symptoms of fever, sore throat, or irritation in the mouth occur, a health care provider should be notified. Rarely, mirtazapine may lower blood counts, causing people to be at an increased risk of serious complications, including infections. Mirtazapine may increase the tendency for seizures . As a result, it should be used carefully in people with epilepsy or other seizure disorders. Mirtazapine may alter moods or cause mania. It should be used carefully in people with a history of mania. Mirtazapine may alter liver function and should be used cautiously by those with a history of liver disease. If abdominal pain, yellowing of the skin or eyes, darkening of urine, or itching occurs, a health care provider should be notified immediately.

More than 50% of individuals using mirtazapine report feeling sleepier than normal and 7% feel dizzy. As a result, people taking mirtazapine should not participate in activities that require mental alertness—like driving— until they know how the drug will affect them. Because there is an increased likelihood of suicide in depressed individuals, close supervision of those at high risk for suicide attempts using this drug is recommended. Mirtazapine is not recommended in pregnant or breast-feeding women.

Side effects

The most common side effects that cause people to stop taking mirtazapine are sleepiness and nausea. Other common side effects are dizziness, increased appetite and weight gain. Less common adverse effects include weakness and muscle aches, flu-like symptoms, low blood-cell counts, high cholesterol, back pain, chest pain, rapid heartbeats, dry mouth, constipation, water retention, difficulty sleeping, nightmares, abnormal thoughts, vision disturbances, ringing in the ears, abnormal taste in the mouth, tremor, confusion, upset stomach, and increased urination.

Interactions

Use of mirtazapine with antidepressants referred to as monoamine oxidase inhibitors (MAOIs) such as Parnate ( tranylcypromine ) and Nardil ( phenelzine ), is strongly prohibited due to the potential for high fever, muscle stiffness, sudden muscle spasms, rapid changes in heart rate and blood pressure, and the possibility of death. In fact, there should be a lapse of at least 14 days between taking an MAOI and mirtazapine.

Because mirtazapine may cause drowsiness, it should be used carefully with other medications that also make people prone to sleepiness, such as antidepressants, antipsychotics, antihistamines, anti-anxiety agents, and alcohol. Increased sleepiness has been reported when mirtazapine was used with both alcohol and the anti-anxiety drug diazepam .

See also Depression and depressive disorders

Resources

BOOKS

Ellsworth, Allan J., and others. Mosby's Medical Drug Reference. St. Louis, MO: Mosby, Inc, 1999.

Facts and Comparisons Staff. Drug Facts and Comparisons. 6th Edition. St. Louis, MO: Facts and Comparisons; Philadelphia: Lippincott Williams and Wilkins, 2002.

Organon Staff. Remeron Package Insert. West Orange, NJ: Organon Inc, 2001.

Kelly Karpa, RPh, Ph.D.



User Contributions:

Hazel
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Aug 4, 2010 @ 11:11 am
I have taken my first dose 15mg last night at 11.30pm and found it impossible to wake up this morning, I am only just starting to function now and even that is extremely slowly... I have had my anti depressants changed twice over the past two weeks, as since the loss of my son nothing seems to help. I have a strnage tingling in my mouth and lips almost as though a local injection were wearing off from the dentist. Is this normal? I really dont feel right at all :-(
MIranda
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Sep 4, 2010 @ 2:02 am
Dear Hazel,
My psychiatrist put me on 7.5 mg of Mirtazapine which obviously is less than what you are taking but it took a few days to over come the side effects which involved me feeling very dizzy and sleepy. It is worth waiting a few days and being patient to let your body get used to the drug. I was lucky enough to be in hospital when I first was taking the drug so I could just go to bed but felt so much better and started sleeping really well and the side effects disappeared after a few days.
I hope that helps.
Shannon
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Oct 24, 2010 @ 2:14 pm
Hello,

I have been taking Mirtazapine for about 2 wks now. I have gained 9 lbs. in the 2 wks. since taking this drug! I am 35 yrs old and have NEVER struggled with my weight or had a weight issue. Besides the weight gain, Mirtazapine does seem to help with my depression. Will the side effect of the weight gain eventually go away or should I stop taking it? Thank you.
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Nov 23, 2010 @ 2:14 pm
I have been taking 15mg for around three weeks and I too have difficulty getting up in the morning. I am feeling less anxious but I cannot get up! I am not happy about taking them, but the Doctor seems to think the sleepiness will subside. I hope so :(
Legin
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Dec 30, 2010 @ 11:23 pm
I have now tried these on 2 occasions. Both times sleepy yes, took all morning to wear off. Haven't had time to assess for anxiety but really bizarre reactions. Feeling of 'swirling' in the head, hot, very uncomfortable, vivid strange dreams, a feeling like all my internals are expanding and swelling! Very strange drug this, or else it's me. I read that there's no chance of serotonin poisoning as there is with some anti's so I'll try again tonight and cut dose to 7.5.
cheers and good luck all.
Tony
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Feb 14, 2011 @ 4:04 am
Took my first dose of mirtazamine 15mg last week at around 10.30pm, by 11pm could hardly stand up or keep my eyes open, slept soundly 'til about 1.30am, had to get up as I couldn't keep still, all my nerves seemed alive, tried to relax but it was impossible to sit still, legs jigging, twitching sensation,/skin crawling, all over. Finally had to take 2 Diazapam 5mg to calm down and get back into bed and sleep. Slept almost the whole next day and still felt lethargic the following day. Not sure if the mixture of the two tablets caused the tiredness???
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Feb 14, 2011 @ 3:15 pm
my mother is 70 years old her psychiatrist put her on 15mg of Mirtazapine, after 3 hrs her Bp was drop to 110/70 although she is hypertension she start sweating and her lower limbs became cold, she has urine retention for 15hrs ,we took her to the hospital to insert catheter she is still dizzy and sleepy , her blood prssure become normal after 10 hrs (140/90) her left hand became week. tomorrow I am going to see her psychiatrist regarding to this side effect
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Feb 16, 2011 @ 10:10 am
I have just started taking these antidepressants and my appetite has doubled I am already too heavy for my height surely this.is not a good thing.as it makes me even more down, anyone else getting this and of so.can you please help me w
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Feb 16, 2011 @ 2:14 pm
Hi,
My mother (patient of PD) took mirtazep 15 mg on Monday night at 10 pm approximately and in tuesday morning she took PK merz 100mg and jumex 5mg since then she is sleeping for almost 18 hrs per day that is on tuesday and wednesday, Can any one advise is it something associated with the side effects of the medicines. She has discontinued the medicine till we get in touch with her doctor again.
Advise PLEASE
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Jul 22, 2011 @ 9:09 am
I took the 15mgs. as advised by my doctor and was asleep within 20 minutes,took it again the next night,same thing. Woke up the next day and almost had a seizure. I was jerking and twitching for an hour. It did aggravate my seizure disorder...
Sheila
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Aug 16, 2011 @ 2:14 pm
I have been taking 15mg for well over a year. I am not depressed or I don't feel like I'm depressed. I sleep maybe a total of 4 hours a night! The 15 mg does not make me feel the least bit drowsy! Dr. says keep takin' them but am really ready to try something else. I am also on another anti-depressant that I take with this (100 mg zoloft) and many more medications. Should I up the mirtazipine to 30 mg a night? Suggestions please!
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Sep 5, 2011 @ 6:06 am
I have just started taking the 15mg dose per day and feel totally out of it and spaced out during the day, all I want to do is sleep...is this normal?
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Nov 9, 2011 @ 3:15 pm
I have been taking these tablets for 5days now, feel very strange,i cant stop eating, things that i would not normally eat,but i have to keep eating until i am almost sick,i am at slimming world,and had been doing extra well,now i have gained 6lb.I have a very sore mouth full of blisters,and my tongue is very red and thick looking.I attend a lipid clinic for high cholesteral and am on tredaptive 20mg each at night along with Lipitor40mg(atorvastatins).I cannot wake up properly for about 2hrs, as i am having very vivid dreams, i feel as if i have been drinking alcohol the night before.I am always tired and have a sensation in my head and ears,and am weak and sore all over,Please can you guide me what to do,as i cannot get an appointment with my GP for several days.
Alice
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Dec 22, 2011 @ 4:16 pm
Hi Caroline,

thank you for your message, that does sound very reassuring. i have been on like 8 different pills since i was 14, im 20 now... its rubbish and i want to find something that works. if this doesnt then i will prob have to go back into hospital... which sucks!

i am a keen runner and i go for like an hour every day... yet this weight wont shift. really not helping my Bullemia unfortunatly. I just feel like a Zombie, not happy, not sad... but just existing... its horrible!

Alice x
Natasha
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Dec 26, 2011 @ 12:12 pm
Hi Alice,

just read your comments on here. it is very sad that you have been on so many anti depressants and you are so young!

I would say stop taking them if they are making you feel like this. either that or you will end up topping yourself by the sounds of things. is there even anyone in your life who cares anyway? only you dont mention of any one. So why don't you just do it anyway? Caroline is talking a load of rubbish. egnore her, she is making out as if she cares but she doesnt so just bloody well do it and be dont with it.

kind regards,

Natasha
Diana
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Jun 13, 2012 @ 8:08 am
I have been to my GP this morning because the venaflaxine I've been taking doesn't seem to be doing anything for me. I am depressed but also have anxiety problems. General, social and compulsive anxiety. I have dreams that upset me and cause me to wake up, so I always feel sleepy and tired. Because of the sleepiness and tiredness, I am lethargic and don't exercise, so I am overweight too. It is a viscious cycle! I'm hoping the Mirtazapine will calm my anxieties and stop my bad dreams. I think I will feel a whole lot better with adequate sleep.

I'm not depressed all the time. I have some good days where I feel good and have plenty of energy. But on a bad day, I will sleep on the sofa all day, wearing my pyjamas, not eat nor even brush my teeth. Then I will feel very lonely and unloved. Then I cry and cry and feel so bad that I think the world would be a better place without me. It's really horrible. My bad dreams are usually fear based. I can't find my car or I get lost and it is exhausting trying to find my way. Or I have pets that I love and I haven't fed them or they run away and get lost and I can't find them. The dreams have changed over the years but they have the same effect on me.

My anxieties have been a part of my life since I was about 9 years old. I have been through a myriad of compulsions and social 'butterflies'. The most prominent is avoiding being around other people. My friends would call me and I wouldn't answer the phone. They would come over to take me out with them for the night and I would pretend I wasn't home. I wouldn't go to the store or out to eat. Not even for fast food. Now I am single again, I chat to potential dates online or on the phone, but I nearly always cancel dates to meet in person. I joined a social club and at the very first meeting, became very sweaty and ill. I had to leave before I fainted.
I order my food, clothes and everything online. Occasionally, I have to go out but I return home as quick as I can. My compulsions have included everything from spelling words in my head, counting, pulling my hair, chewing my lips and fingernails and picking the skin on my feet. I will not stop until I am bleeding and in pain. It's very weird and most of the time I'm not aware that I'm doing it. But walking on sore feet is a constant reminder.

Re-reading this, I think I sound pretty messed up! I am trying to feel better. Fingers crossed, the Mirtazapine will work!
Sarah
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Jul 15, 2012 @ 3:15 pm
my family Dr put me on this medication but it was NOT for depression. I have had serious muscle contractions (dislocated shoulder a several occassions, stress marks on bones and pulled spine board straight) and a bad burning sensation in left arm shoulder and entire back. This medication made my entire body go numb. My mouth felt like my dentist shot it full of novicane. I slept for hours and when I was awake I was dizzy, my grandmother said I was like a walking dead person I was out of it. Another time I took this medication on a Friday just to wake up on a Sunday. My Dr also started me out on a 45mg dose. This is a drasticly higher dosage then what I have been reading from previous comments. My husband works out of state A LOT and I didnt feel as if I could function with 2 children in my house driving them to and from schhol sports dance etc. Has anyone else experienced these kind of issues? The medication worked very well for what I needed it to but I could not function, my neuro Dr thinks I have fibromialgia, so my next question is, Has anyone else used this for fibro?
Sam
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Aug 5, 2012 @ 9:09 am
Hi, i started with my first dose of 30mg at 10 pm last night, by 10.30 i felt so tired and dizzy, and my speech was slury. I went to bed and my legs seemed so restless. Went straight to sleep and slept for 16 hours straight. Woke up feeling strange and a horrible taste in my mouth, only just starting to feel normal again. I was taking 40mg of Citalopram but my doctor took me off that and told me to start on 30mg of this medication. Is that normal to start on a high dosage ??
dd58
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Aug 7, 2012 @ 12:00 am
Hi.is there anyone out there that is on Mirtazapinne,lithium and Nitrazepam(sleeping tablet).I am taking 15mg mirtazapine,500mg lithium and 10mg nitrazepam,I take these all at night.Yet I am still not able to sleep through the night.I really do not like taking this combination of tablets,especially the lithium carbonate.I suffer from depresion and have been admitted 3 times in the past 2 and half years.Although I don't sleep through the night,I feel drowsy all day,THERE are times that I just sit and cry,because I feel so tired.
donna
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Aug 12, 2012 @ 10:10 am
Hi Everyone. thought i would throw in my experience with remeron. i suffer from anxiety, agoraphobia, and was diagnosed bipolar 1. i was given .05 xanax 4 times daily, vistaril 25mg 4 times daily, and depakote 725 mg daily plus remeron 15 mg at bedtime. i had no problems for first 7 days. i slept well, no hangover feelings, i actually felt good for the first time in a long time. then the mouth soreness started, which turned into ulcers. i could barely swallow. since i hadnt started seeing my doctor yet outside of the hospital, i got my pharmasist to help figure out which med was causing this. it was remeron. i was disappointed it caused problems. so i can recommend that if anyone has mouth ulcers, what worked best for me was mylanta. wish you all the best.
Hayley
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Aug 14, 2012 @ 3:03 am
Hi all,
Ive been taking Sertraline for past month due to increased anxiety, But due to lack of libido my doctor took me off of them and put me on 15mg of Mirtazapine, forgot to take at night and took as per usual yesterday morning - within half hour I felt drunk and couldnt keep my eyes open, had to lay on settee where I spent most of the day asleep - woke up to fill my face (am already overweight) went to bed at 11pm and slept til 8am this morning making a total of 18hrs sleep I have a 9yo son (on hols with his dad til tonight) and cant afford to feel like this, do you think it will pass or shall I go back on the previous medication ?
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Aug 14, 2012 @ 2:14 pm
Remeron is great at putting you to sleep, but it is horrible for waking up. Remeron causes the worse morning depression imaginable. It is like waking up in a concentration camp. At least Ambien makes you a little cheerful. However, Remeron is monstrous in the morning. I have no idea how many lives this horrible drug has destroyed. My question is what in the heck where they thinking when this drug was concocted. Did they have any knowledge of how the human brain works?
Keep it simple and take 1mg of Xanax. Stay away from this crap drugs like Zoloft(school shooting drug), Paxil, and Prozac(another school shooting drug.
Why do people put this shit into their bodies.

I am playing it safe with Ambien and Xanax, and staying away from the garbage.
Krystle
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Aug 19, 2012 @ 2:14 pm
Hi people i've been takeing Mirtazapien for 2 months now and still on them they are the worst anti depression tablets i have been on im normally a very outgoing happy go lucky person when im not depressed i suffer from o.c.d and aniexty too this is why i am on tablets i've been on a numerous set of tabelts from Fluextine to Citraploram but since takeing these tablets which 45mg everynight im asleep within 20 mins and then i sellp right thru the night till saay 2 to 3 in the afternoon pm which the time i wake up the day has gone by and im very moody and angry i then went to my gp which is a differebt gp everytime i go to the doctors i've explaind to him that anti depressants DO NOT make you better they make u feel worse so from now on im weeneing myself off them and focusing on the good times in life ive learnt to have good friends eat healthy dont drink so much or take drugs go to a gym get a good part time or fulltime job and not let depression get me down i hope my info can help somebody and remebmber life is how you make it :) good luck readers. k.b Plymouth Try not to put shit into youre bodys.
CHRISTINE
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Aug 19, 2012 @ 4:16 pm
Taken mirtazapine for 4 months had nothing but trouble inc blood pressure dropping to 90 over 50 dizziness lethargyawful restless legs at night Havent felt well since taking it and I have had enough so off to docs tomorrow to get off these nasty pills and hopefully change to something that doesnt make me feel like a dead man walking with attitude
Christine
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Aug 20, 2012 @ 8:20 pm
Hi, Dont know if this will help any one, but i wanted to write in about my story. I started on Mirtazipine 30MG around 2008. I had several panic attacks due to alot of stress in my life. Mitazipine made me gain 7 kilos within a month and i felt like a walking zombie each and every day. It did help me get over the panic attacks eventually, but every day it was a struggle to wake up, bright lights bothered me, i felt dizzy, lethargic and really just not with it. I decided a year or so into into to reduce the amount to 15MG and i have been on that ever since. Everyday still is a struggle to get out of bed, I have no energy ever, I never wake up feeling positive and ready to take on the world, i have the most awful taste in my mouth every single day (almost as if my teeth are dying its that bad), My whole body aches, My feet and palms are sweaty all the time, I get dizzy easily, I cant handle bright lights, My joints fill so stiff. I find the less i sleep the worse i feel. Yes the more i sleep the gluggier i feel. I cant win. I know im wasting my life away and i know i need to get off these pills asap! I have had several bloood tests and everything has come back fine except my cholestral levels are VERY high. I am nearlly 100% that all of these symptoms now after reading this forum is due to taking mirtazipine 15mg. Im going to book into a dr as soon as i can and try to get off these evil tables. Has any one else has bad withdraw symptoms? Or any of these symptoms each and every day as i have said? Thanks.
Christine
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Aug 20, 2012 @ 8:20 pm
Not to mention i have a loose tummy often, need to wee alot, twitching alot (im always tapping my foot, cant stay still) and i am nervous alot of the time. I honestly think the tablets are making me worse not better!
Josephine
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Aug 30, 2012 @ 7:07 am
I have been taking Mirtazapine for a year now- 30mg although I have just reduced down to 15mg. It is the best anti-depressant I have taken (I've tried 6 different types) and helps with both my depression and anxiety. I too found for the first time in my life I was gaining weight and was prone to lethargy- there is a solution! I have an exercise programme in which I intend high intensity crossfit sessions (these not only help with the weight but also the energy levels and mood), I also changed my diet to one which is high in protein (fresh meat/fish/chicken and lots of green vegetables) this also has the effect of keeping my weight in check, giving me energy and also keeps my blood sugars stable which helps with my moods. Lastly I started attending a weekly meditation class which helped with mental and over all well being. I guess my message is not to expect a drug to be a magic bullet- change your lifestyle and you can be so much happier and healthier.
char
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Mar 16, 2013 @ 4:16 pm
I have been on Mirtazapine 15 MG two weeks. It is making me extremely tired and listless. I want people to know how it will intensify the effects of alcohol. Be very careful. I collapsed and passed out. I now have a black eye and severely bruised cheek bone. I will be looking for a different medication.
Janette
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Aug 1, 2013 @ 4:16 pm
Have been on 30 mg remeron for about 8 weeks. However several weeks after starting it my toes are constantly red, my hands are swollen every morning and I'm bruising very easy. All of these things started after the remeron so the only way to know if its causing these issues is to pull me off. Bummer because I finally had something that helped. Something I had hoped would not cause additional problems. 6th med I've tried all have give. Me side effects. I'm obviously sensitive to most of these drugs. Thought I'd post this in case someone else was having these issues after starting remeron.
Kate
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Aug 3, 2013 @ 7:07 am
I started 15MG Mirtazapine 4 months ago. Two weeks later my Doc told me to take 30MG, after 3 months Im now on 45MG. After an awful first month, I thought i had found the best anti depressant,(allowing myself to cope with side effects). But i cant take anymore, Im back to not being able to sleep, sometimes crying in bed because im so tired and cant get up to keep busy. And feel so angry and irritated. Once i finally do fall asleep, I SLEEP, but its a nightmare getting up. Infact sometimes i have to drink a bottle of wine to knock me out. I have also gained loads of weight. The only good thing about these tablets is i no longer pull my hair( Trichotillomania). But to be honest i think i would go back to suffering from that, than the irritable, angry feeling i have.
ella
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Sep 5, 2013 @ 5:05 am
Ella
I have only taken 15 mg a single dose of Mirtazapine about 19.00 pm last night. I have been sleeping til 7.00 a.m this morning but I can not wake up completely and is almost 12.00. I had urine retension this morning and a fever of 37.5 C and some problems vith my vision. I don't think I'll take a second dose.
Nikki
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Sep 10, 2014 @ 5:05 am
Hey, iv just been changed from 100mg of sertriline to 45mg of this stuff, ment to take my first dose tonight but slightly weary after all off your comments . Is it worth it ?!! X

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