From the Guidelines
Mirtazapine is an effective treatment for major depressive disorder, particularly for patients with insomnia or appetite loss, due to its sedative effects and ability to stimulate appetite. The typical starting dose is 15 mg taken once daily at bedtime, which may be increased gradually to 30-45 mg per day based on response and tolerability 1. Mirtazapine works by increasing levels of norepinephrine and serotonin in the brain, and its sedative effects are typically more pronounced at lower doses (15 mg) and may decrease at higher doses.
Some key points to consider when prescribing mirtazapine include:
- Common side effects include drowsiness, increased appetite, weight gain, and dry mouth 1
- Mirtazapine should not be combined with MAO inhibitors, and alcohol consumption should be avoided while taking this medication 1
- Unlike some other antidepressants, mirtazapine has minimal sexual side effects and is less likely to cause nausea or anxiety, making it a good option for patients who cannot tolerate SSRIs 1
- Mirtazapine may also be used off-label for the treatment of insomnia, particularly in patients with comorbid depression 1
It's worth noting that while mirtazapine is effective for treating depression, it may not be the best option for all patients. For example, patients with a history of seizures or epilepsy should use mirtazapine with caution, as it may lower the seizure threshold 1. Additionally, mirtazapine may interact with other medications, such as warfarin and diazepam, so patients should be closely monitored for potential interactions 1.
Overall, mirtazapine is a useful treatment option for patients with major depressive disorder, particularly those with insomnia or appetite loss, and its sedative effects and ability to stimulate appetite make it a good choice for patients who cannot tolerate other antidepressants.
From the FDA Drug Label
Mirtazapine tablets are indicated for the treatment of major depressive disorder (MDD) in adults [see Clinical Studies (14)]. The use of Mirtazapine (Remeron) is for the treatment of major depressive disorder (MDD) in adults 2.
- Indication: Major depressive disorder (MDD)
- Population: Adults
From the Research
Use of Mirtazapine (Remeron)
Mirtazapine, also known as Remeron, is a noradrenergic and specific serotonergic antidepressant (NaSSA) used in the treatment of major depression 3, 4, 5, 6, 7. The primary use of mirtazapine is for the treatment of depression, including major depressive disorder.
Therapeutic Effects
The therapeutic effects of mirtazapine include:
- Antidepressant effects: Mirtazapine has been shown to be effective in treating major depression, with improvements in depressive symptoms and quality of life 3, 4, 5.
- Anxiolytic effects: Mirtazapine may also have anxiolytic effects, making it useful for treating anxiety disorders, including post-traumatic stress disorder, panic disorder, and social anxiety disorder 5.
- Sedative effects: Mirtazapine has sedative properties, which can be beneficial for patients with insomnia or other sleep disturbances 3, 6.
Mechanism of Action
The mechanism of action of mirtazapine involves:
- Blockade of presynaptic alpha 2-adrenergic receptors, which increases noradrenergic activity 6, 7.
- Blockade of postsynaptic serotonin type 2 and type 3 receptors, which increases serotonergic activity 3, 6, 7.
- Antagonism of central and peripheral histamine H1 receptors, which contributes to its sedative effects 7.
Dosage and Administration
The recommended dosage of mirtazapine is 15-45 mg/day, administered in a single dose at bedtime 3, 6, 7. The starting dosage is typically 15 mg/day, which can be increased as needed and tolerated.