Can magnesium glycinate be used to support mirtazapine (Remeron) therapy?

Magnesium Glycinate and Mirtazapine: No Evidence for Supportive Interaction

There is no clinical evidence that magnesium glycinate provides any therapeutic support or enhancement to mirtazapine therapy, and this combination is not recommended in any clinical guidelines for depression or anxiety management.

Evidence Review

Absence of Supporting Data

• No guidelines or research studies identified any role for magnesium glycinate in supporting mirtazapine therapy 1, 2
• Mirtazapine's mechanism of action involves noradrenergic and specific serotonergic effects through α2-adrenergic receptor antagonism and 5-HT2/5-HT3 receptor blockade, which are unrelated to magnesium's pharmacological properties 3, 4, 5

Limited Role of Magnesium in Psychiatry

• Magnesium is indicated only for documented hypomagnesemia or torsades de pointes (polymorphic ventricular tachycardia with prolonged QT interval) 1
• In stroke management, trials of magnesium as a neuroprotective agent showed it may be relatively safe but demonstrated no consistent clinical benefit 1
• There is insufficient evidence to recommend magnesium for routine use in cardiac arrest or other acute medical conditions 1

Mirtazapine's Established Profile

• Mirtazapine is effective as monotherapy for major depression at doses of 15-45 mg daily, with rapid onset of action comparable to or better than tricyclic antidepressants and SSRIs 5, 6
• The drug's efficacy is well-established without any adjunctive agents, and combination therapy is only considered when initial monotherapy fails 1, 7
• Common side effects include sedation, increased appetite, weight gain, and dry mouth—none of which are mitigated by magnesium supplementation 3, 4, 6

Clinical Implications

If you are considering magnesium supplementation alongside mirtazapine, the only valid indication would be documented hypomagnesemia, which should be treated regardless of psychiatric medication use 1. There is no pharmacological rationale for combining these agents to enhance antidepressant efficacy, reduce side effects, or improve any clinical outcome related to depression or anxiety management 1, 2.

Common Pitfall to Avoid

• Do not confuse magnesium's role in acute medical emergencies (cardiac arrhythmias) with any psychiatric application 1
• Avoid polypharmacy without evidence-based rationale, as mirtazapine monotherapy is effective for most patients with major depression 5, 6