From the Research
For treatment-resistant depression, mirtazapine (Remeron) at 15-45 mg at bedtime is recommended to be used in combination with venlafaxine (Effexor) to enhance effectiveness, as it may help with sleep and appetite issues while complementing venlafaxine's mechanism 1.
Key Considerations
- When adding mirtazapine to venlafaxine, start with low doses and titrate gradually while monitoring for side effects, particularly serotonin syndrome with certain combinations.
- The combination of mirtazapine and venlafaxine has been shown to be effective in treating treatment-resistant depression, with response rates of 44% at 4 weeks and 50% at 8 weeks 2.
- A more recent study found that the combination of mirtazapine and venlafaxine produced a response rate of 81.8% and a remission rate of 27.3% in patients with major depression 3.
- Another study found that the combination of mirtazapine and venlafaxine was more effective than fluoxetine monotherapy, with remission rates of 58% for mirtazapine plus venlafaxine compared to 25% for fluoxetine monotherapy 1.
Important Safety Information
- Monitor patients for side effects, particularly serotonin syndrome, when combining mirtazapine and venlafaxine.
- Regular blood work should be performed when using this combination, and metabolic monitoring is necessary.
- The combination of mirtazapine and venlafaxine may increase the risk of adverse effects, such as sedation and weight gain 2.