From the Research
Trazodone and mirtazapine (Remeron) can be used together for treating depression and sleep disorders, though this combination should only be taken under medical supervision. Both medications affect serotonin levels in the brain but work through different mechanisms. Trazodone primarily blocks serotonin receptors and has sedative properties, while mirtazapine affects both serotonin and norepinephrine systems with strong antihistamine effects that promote sleep. When prescribed together, trazodone is typically given at 50-150mg at bedtime for sleep, while mirtazapine doses usually range from 15-45mg daily, also often taken at night.
This combination may provide enhanced antidepressant effects and better sleep improvement than either medication alone, as suggested by a case report where the addition of trazodone to a dual combination of paroxetine and mirtazapine led to the remission of depressive symptoms in a patient with treatment-resistant depression 1. However, patients should be aware of potential side effects including increased sedation, dizziness, dry mouth, and rarely, serotonin syndrome. The risk of serotonin syndrome is a concern when combining serotonergic medications, but a review of case reports suggests that this risk is not a contraindication to the use of trazodone with other antidepressants, although caution and monitoring are advised 2.
Regular follow-up with a healthcare provider is essential to monitor for side effects and adjust dosages as needed. Patients should never adjust doses or stop either medication without medical guidance due to potential withdrawal effects. Mirtazapine has been shown to be effective in the treatment of major depression, with a rapid onset of action and a high sustained remission rate 3, and trazodone has been investigated for its utility in various disorders, including insomnia, anxiety disorders, and chronic pain 4.
Some key points to consider when using trazodone and mirtazapine together include:
- Monitoring for increased sedation and adjusting doses accordingly
- Being aware of the potential risk of serotonin syndrome and monitoring for symptoms such as agitation, confusion, and changes in blood pressure
- Regular follow-up with a healthcare provider to adjust dosages and monitor for side effects
- Not adjusting doses or stopping either medication without medical guidance due to potential withdrawal effects.