What is the use of Remeron (Mirtazapine)?

From the Guidelines

Remeron (mirtazapine) should be initiated at a dose of 7.5 mg at bedtime, with a maximum dosage of 30 mg at bedtime, as it is potent and well tolerated, promoting sleep, appetite, and weight gain 1. The medication works by blocking certain serotonin receptors while enhancing norepinephrine and serotonin neurotransmission, which helps improve mood, sleep, and appetite. Some key points to consider when prescribing Remeron include:

• Common side effects include drowsiness, increased appetite, weight gain, and dry mouth
• The sedative effect is often strongest at lower doses and may decrease at higher doses
• Patients should take Remeron consistently at the same time each evening and avoid alcohol while using this medication
• It typically takes 2-4 weeks to experience the full antidepressant effects
• Remeron should not be stopped abruptly; dosage should be gradually reduced under medical supervision to prevent withdrawal symptoms
• This medication may be particularly beneficial for patients with depression accompanied by insomnia or poor appetite, as supported by guidelines for managing chronic insomnia in adults 1 and the use of second-generation antidepressants to treat depressive disorders 1.

From the FDA Drug Label

Mirtazapine tablets are indicated for the treatment of major depressive disorder (MDD) in adults [see Clinical Studies (14)]. The drug is known as mirtazapine and is also referred to as Remeron. It is used for the treatment of major depressive disorder (MDD) in adults 2.

From the Research

Overview of Remeron (Mirtazapine)

• Remeron, also known as mirtazapine, is a noradrenergic and specific serotonergic antidepressant (NaSSA) used in the treatment of major depression 3.
• It is approved in many countries for use in the treatment of major depression and has been shown to be effective in improving depressive symptoms in patients with major depression, including the elderly 3.

Efficacy and Comparison to Other Antidepressants

• Mirtazapine has been shown to be as effective as other antidepressants, including selective serotonin reuptake inhibitors (SSRIs), in the treatment of major depression 3, 4.
• A meta-analysis of clinical trials comparing mirtazapine with SSRIs found that patients randomized to treatment with mirtazapine were as likely to experience clinical response as patients randomized to treatment with an SSRI 4.
• Mirtazapine may have a more rapid onset of action than SSRIs and may have a higher sustained remission rate than amitriptyline 3.

Side Effects and Tolerability

• Mirtazapine is generally well tolerated in patients with depression, with common side effects including drowsiness, excessive sedation, dry mouth, increased appetite, and body weight gain 5.
• Mirtazapine has been shown to have a lower incidence of anticholinergic and neurological adverse events compared to tricyclic antidepressants (TCAs) 5.
• A study comparing mirtazapine with SSRIs found that mirtazapine-treated patients were less likely to experience insomnia, nausea, and other side effects, but more likely to experience fatigue, excessive sleepiness, and weight gain 4.

Dosage and Administration

• The recommended starting dosage of mirtazapine is 15 mg/day, with a gradual increase to 30 mg/day and potentially up to 45 mg/day if necessary 5.
• A systematic review and dose-response meta-analysis found that the lower range of the licensed dose of mirtazapine (around 30 mg) achieves the optimal balance between efficacy, tolerability, and acceptability in the acute treatment of major depression 6.

Use in Treatment-Resistant Depression

• A study investigating the use of mirtazapine in combination with SSRIs or serotonin-noradrenaline reuptake inhibitors (SNRIs) for treatment-resistant depression found no convincing evidence of a clinically important benefit for mirtazapine in addition to a SSRI or a SNRI antidepressant over placebo 7.