Other Forms: You might be able to get it in pill form. These days Remeron SolTab - the orally disintegrating tablet - is the main way it’s prescribed and dispensed.
|US brand name: Remeron
| Generic name: mirtazapine
Class: Antidepressant. Specifically a Tetracyclic Antidepressant. Even more specifically a noradrenergic and specific serotonergic antidepressant (NaSSA), but is the only one available in the US.
1. Other brand names & branded generic names1
- Avanza (Australia)
- Axit (Australia)
- Mirtabene (Austria)
- Remergon (Belgium)
- Norset (France)
- Remergil (Germany)
- Mirtaz (India, Sri Lanka)
- Rexer (Spain)
- Zispin SolTab (United Kingdom, Ireland)
2. FDA Approved Uses
Major depressive disorder
3. Off-Label Uses
- Sleep Disorders
- Bipolar Depression
- And all sorts of things that keep you from sleeping well, like
- Chronic Fatigue
- Irritable Bowel Syndrome
- To treat some very specific auditory hallucinations
4. Remeron Pros and Cons
- If serotonin and/or norepinephrine are the answer for you, it will pull you out of the deepest, blackest depression like no other medication will.
- It may not be as good as Seroquel or Zyprexa for knocking you out, but it’s better than trazodone for the combination of depression and insomnia.
- You may literally eat sugar straight out of the bag to satisfy your cravings for sweet carbohydrates. By “literally” I mean I have received e-mails from, and read reports by, people who have done exactly that.
- You may sleep too well.
- Has one of the highest poop-out (tachyphylaxis) rates of any med, antidepressant or otherwise.
5. Side Effects
5.1 Typical Side Effects
Most of the anticholinergic effects common with psychiatric medications (e.g. constipation, confusion, loss of coordination, memory loss) are infrequent. Instead you get intense hunger for the wrong foods, and with that comes weight gain, dry mouth and constipation caused by what you eat and not the drug itself. Then you want to sleep a lot. It’s like you may as well be smoking pot. Except usually less fun. Although Remeron won’t make your bipolar disorder (or schizophrenia) a lot worse like cannabis will.
5.2 Not So Common Side Effects
Edema, dizziness, low blood pressure, increased thirst to go with the munchies, ‘flu-like symptoms.
5.3 Freaky Rare Side Effects
Going deaf and various flavors of herpes. Yeah, right, it was the Remeron that gave someone that STD. (See this review for how the herpes thing really works.) The deafness (the PI sheet doesn’t indicate to what extent or for how long) is an example of my “side effects are sometimes like allergies” corollary to the “allergies are leftover immune responses to diseases that no longer exist” hypothesis. But only if you consider the case studies referenced above about using Remeron to treat auditory hallucinations. It’s not as strong a connection as the one for the whole-body muscle aches caused by Topamax and Lamictal being related to how well they treat atonic (drop) seizures.
Remeron also carries a warning for agranulyocytosis, the severe reduction in white cell count, along with fever, infection and all that fun stuff. That hit Mouse like a ton of bricks. She was stuck in a motel in Fairfield for a week after one dose.
6. Interesting Stuff Your Doctor Probably Won’t Tell You
- Remeron appears to be subject to a really quick poop-out, like after just a month or so. Works great, then quits on you.
- Remeron will make you more drunk. So while liquor as no effect upon Remeron, the opposite is not true, so be extra careful if you want to have the occasional drink.
7. Dosage and How to Take Remeron
The initial is 15mg. If no improvement is felt within two weeks, that may be increased to 30mg. If you’re still not feeling better a month after that, you can go up to 45mg and officially that’s it, although there are reports of some psychiatrists experimenting with doses up to 90mg. There are no other published dosage options for Remeron at this time, it’s just weird that way. 15, 30 or 45mg. Some of the more enlightened doctors are starting their patients at 7.5mg and titrating them in 7.5mg increments, and I’m all for that method. If I were you, and I got along with meds that messed with my serotonin, I’d insist on that. 7.5mg to start, up to 15mg after a week or two if no improvement, then 22.5mg after a month and so forth up to 45mg. I think the 90mg craziness is in response to Remeron poop-out, which is just exposing people to side effects for no good reason.
8. How Long It Takes to Work
- For depression: one to two weeks.
- For sleep: usually the night you take your first dose, the second night at the latest. If Remeron doesn’t make you tired at 15mg a night, don’t bother.
9. How to Stop Taking Remeron
Your doctor should be recommending that you reduce your dosage by 7.5 - 15mg a day every week if you need to stop taking it, if not more slowly than that. Based on the 20–40 hour half-life.
10. Half-Life & Average Time to Clear Out of Your System
Mirtazapine’s half-life is 20–40 hours. The average is 26 hours for guys and 37 hours for girls. Girls always take longer. So mirtazapine is out of a guy’s system in about five days while it’s out of a girl’s in about seven days.
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream2
, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what3
, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.
11. Days to Reach a Steady State
Steady state is usually reached in five to seven days.
Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.
12. Shelf life
13. How Remeron Works
Being the only noradrenergic and specific serotonergic antidepressant (NaSSA) approved for use in the US makes the way it works somewhat unique. In Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series)
Stahl describes the mechanism as stepping on the accelerator and cutting the brakes of norepinephrine and serotonin. I think of it more like having your brain sit in a jacuzzi instead of just marinating tasty brain juices for longer the like SNRIs
such as Cymbalta
] would do. SNRIs
aren’t able to target where they work, while mirtazapine can, as it is an agonist at the serotonin 5-HT1A
receptors and an antagonist at 5-HT2A
. It’s also an extremely potent antihistamine. In English: That’s why it’s a super-effective antidepressant/anti-anxiety med and sleeping pill that can poop-out quickly and literally make you eat sugar right out of the bag.
At any dosage it will make you crave doughnuts. Seriously. You will want to invest in Krispy Kreme stock (or maybe something along similar lines that isn’t tanking); as Remeron’s antagonism of the serotonin 5HT2C and H1 receptors gives you the munchies for carbohydrates and sugars like you were 16 and smoking the best pot ever in the parking lot of a strip mall with a 24-hour doughnut shop beckoning you with glazed and jelly-filled ecstasy. People dipping spoons into a bag of sugar and eating it as is - not unheard of when on Remeron. This stuff is nothing more than legal marijuana, and if I knew crap about biochemistry I could probably prove that crazy statement. From a purely molecular-chemical perspective THC and mirtazapine are nothing alike. But there’s just something about how the two drugs work that is really close. And people who have self-medicated with pot respond really well to meds that really push the norepinephrine, and hard. Strattera
, and the more potent TCAs
. And Remeron.
The production of extra serotonin and norepinephrine, and not just soaking neurons in what neurotransmitters are available for a longer period of time, is sometimes the best solution to recalcitrant depression. When it works it makes people feel really good. I mean really good. This is the closest thing to a happy pill on the market. Until you get all bummed out about how much weight you’ve put on and how little you do because you’re sleeping all the time.
As mirtazapine encourages your brain to actually produce more of the neurotransmitters serotonin and norepinephrine, talk to your doctor about taking their respective precursors, 5-HTP (or l-tryptophan) and l-tyrosine. Neurotransmitter/monoamine depletion
is a controversial hypothesis, but it explains too many things, like antidepressant poop-out (tachyphylaxis) to dismiss outright.
This med is not for mild to moderate depression, it’s for people who are seriously depressed, who are willing to put up with the weight gain and the sleeping because those side effects suck much less than the dark pit of depressive despair one finds oneself in.
You probably don’t want to mix Remeron with Zyprexa
as your choice of antipsychotic
to treat bipolar disorder or severe treatment-resistant depression. One woman I know from the bipolar support forum on about.com
was prescribed that combination as an inpatient in a Canadian hospital. She reported there how she ballooned up in weight, from 103 pounds to 162 pounds, in about six weeks, and carrying that on a 5′ 1″ frame. She gained a pound and a half a day
, eating hospital food! As has been pointed out, that isn’t possible in this universe. Or at least is extremely
unlikely. I have read several reports of people who were on cocktails of Remeron and an antipsychotic
for refractory unipolar or bipolar depression. No one had, or will gain half a kilo a day, but rapid and extensive weight gain is as certain as sunrise over a suburban stripmall being accompanied by the scent of doughnuts.
What doctor in their right mind would prescribe Remeron and Zyprexa
for someone not in their right mind? It’s not as crazy as it sounds: Combined treatment of olanzapine and mirtazapine in anorexia nervosa associated with major depression
, Mirtazapine add-on improves olanzapine effect on negative symptoms of schizophrenia
, and Management of symptons associated with advanced cancer: olanzapine and mirtazapine
. I’m pretty sure she didn’t have cancer, but the other two uses could explain the perception of gaining a pound and a half a day.