From the Guidelines
Mirtazapine should be gradually tapered before discontinuation rather than stopped abruptly to minimize discontinuation symptoms. A typical tapering schedule might involve reducing the dose by 7.5-15 mg every 1-2 weeks, depending on the starting dose and individual response. For example, if someone is taking 45 mg daily, they might reduce to 30 mg for 1-2 weeks, then 15 mg for 1-2 weeks, then 7.5 mg for 1-2 weeks before stopping completely. This gradual approach helps minimize discontinuation symptoms, which can include dizziness, nausea, headache, irritability, anxiety, and sleep disturbances. The tapering schedule should be individualized based on how long the person has been taking mirtazapine, their current dose, and their sensitivity to medication changes. Patients experiencing significant discontinuation symptoms during tapering may benefit from slowing the taper further. The reason for tapering is that mirtazapine affects multiple neurotransmitter systems including serotonin, norepinephrine, and histamine, and the brain needs time to adjust to these neurochemical changes when the medication is withdrawn 1.
Some key considerations for tapering mirtazapine include:
- The dose reduction should be gradual, with a typical reduction of 25% of the daily dose every 1-2 weeks 1
- The tapering schedule should be individualized based on the patient's response and sensitivity to medication changes
- Patients experiencing significant discontinuation symptoms during tapering may benefit from slowing the taper further
- Non-pharmacological interventions, such as cognitive-behavioral therapy, may be helpful in managing discontinuation symptoms and supporting the tapering process 1
It's worth noting that while the provided evidence does not directly address mirtazapine, the principles of gradual tapering and individualized scheduling can be applied to minimize discontinuation symptoms and ensure a safe withdrawal process. As the most recent and highest quality study, the evidence from 1 supports the importance of gradual tapering and individualized scheduling in minimizing discontinuation symptoms and ensuring a safe withdrawal process.
From the FDA Drug Label
A gradual reduction in the dosage, rather than an abrupt cessation, is recommended [see Dosage and Administration (2.6)]. Advise patients not to abruptly discontinue mirtazapine tablets and to discuss any tapering regimen with their healthcare provider. Adverse reactions can occur when mirtazapine tablets are discontinued [see Dosage and Administration (2.6),Warnings and Precautions (5. 14)].
Mirtazapine should be tapered before discontinuation to avoid potential adverse reactions. It is recommended to discuss a tapering regimen with a healthcare provider to ensure a safe discontinuation. 2 2
From the Research
Mirtazapine Discontinuation
- The provided studies do not directly address the need to slowly dose down mirtazapine before discontinuation 3, 4, 5, 6, 7.
- However, it is generally recommended to taper antidepressants, including mirtazapine, when discontinuing treatment to minimize the risk of withdrawal symptoms 3, 4, 5.
- The studies focus on the efficacy, safety, and tolerability of mirtazapine in the treatment of major depression, as well as its pharmacological and clinical profile 3, 4, 5, 6, 7.
- Mirtazapine's unique mechanism of action, involving the antagonism of adrenergic and serotonin receptors, may contribute to its efficacy and tolerability profile 3, 4, 5, 6, 7.
- While the studies do not provide specific guidance on discontinuation, they suggest that mirtazapine is generally well-tolerated and effective in the treatment of depression, with a relatively favorable side effect profile compared to other antidepressants 3, 4, 5, 6, 7.