How to Discontinue Remeron (Mirtazapine) 7.5 mg Daily
For a patient on mirtazapine 7.5 mg daily, you can discontinue the medication without a formal taper by simply stopping it, because this dose is below the therapeutic range and the drug's long half-life (20–40 hours) provides built-in protection against abrupt withdrawal. 1, 2, 3
Rationale for Direct Discontinuation at This Dose
- Mirtazapine 7.5 mg is a subtherapeutic dose used primarily for sedation and sleep rather than antidepressant effect; therapeutic antidepressant dosing begins at 15 mg daily. 1, 3
- The elimination half-life of 20–40 hours means the drug clears gradually over several days even after abrupt cessation, functionally creating its own taper. 2, 3
- General antidepressant discontinuation guidance recommends tapering over 10–14 days to limit withdrawal symptoms, but this applies to therapeutic doses; at 7.5 mg the physiologic burden is minimal. 1
What to Monitor After Stopping
Even though formal tapering is unnecessary at this dose, you should still watch for:
- Rebound insomnia or anxiety in the first 3–7 days, since mirtazapine's histamine (H₁) antagonism provides sedation that will be lost. 4, 3
- Return of the original symptoms (depression, anxiety, or insomnia) that prompted treatment, which may emerge over weeks to months—this represents relapse of the underlying condition, not withdrawal. 5
- Mild transient symptoms such as headache, irritability, or vivid dreams are possible but typically resolve within one week without intervention. 6
When a Gradual Taper Would Be Indicated
A formal taper is necessary if the patient:
- Has been on mirtazapine for more than 10 weeks, even at low doses, because one case report documented severe recurrent panic attacks after abrupt discontinuation of 30 mg following 10 weeks of use. 6
- Is taking multiple psychotropic medications; in that scenario, discontinue adjunctive agents first while keeping mirtazapine stable, then taper mirtazapine last. 5
- Has a history of withdrawal symptoms with missed doses of any antidepressant, signaling heightened sensitivity. 5
If a taper is needed, reduce by 50% (to approximately 3.75 mg, using liquid formulation if available) for 1–2 weeks, then stop. 1
Common Pitfall to Avoid
- Do not assume that symptoms emerging 2–4 weeks after stopping are withdrawal—mirtazapine's half-life means true withdrawal peaks within the first week. Symptoms appearing later likely represent relapse of the original mood or sleep disorder and require reinitiation of treatment or alternative management, not resumption of mirtazapine "to finish a taper." 5, 6
Follow-Up Schedule
- Contact the patient at 1 week to assess for rebound insomnia or transient withdrawal symptoms. 5
- Schedule follow-up at 1 month and 3 months to monitor for return of the original condition (depression, anxiety, or chronic insomnia). 5
- Provide clear instructions to report immediately if depressive symptoms, panic attacks, or severe insomnia re-emerge, rather than waiting for scheduled visits. 5
Alternative Sleep Management
If the patient was using mirtazapine 7.5 mg solely for insomnia:
- Cognitive-behavioral therapy for insomnia (CBT-I) is first-line and superior to medication for long-term outcomes. 7
- Low-dose doxepin 3–6 mg is the preferred pharmacologic alternative for sleep-maintenance insomnia in adults, with minimal anticholinergic effects and no abuse potential. 7
- Avoid substituting another sedating medication (trazodone, benzodiazepines, or Z-drugs) unless there is a specific indication, as this perpetuates pharmacologic dependence on sleep aids. 7