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Mirtazapine is shown to have antidepressant properties as well as many other beneficial uses, ranging from the treatment of anxiety and insomnia to OCD or PTSD. Mirtazapine is a complicated drug with confusing mechanisms of actions, but it also shows promising results in regards to other off-label usages.

NOTE: Selfhacked does not support taking or not taking this or any drug.  We think drugs should be only be tried as a last resort, if needed and/or your doctor recommends it.  Do not take this post as promoting the use of this medication.  It’s for informational purposes alone. It’s a popular drug and people should know what it’s used for, the evidence behind it and its drawbacks.

Introduction to Mirtazapine

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26 COMMENTS

  • steve

    Remeron worked great for me 10 years ago, I just wished it worked again as well.
    The weight gain did suck though

  • Rachel

    Remeron was a saving grace for me! I’ve been on 15mg of it at night for about three years (along with Zoloft for anxiety). I was not sleeping well because of anxiety and my weight was always low from a very high metabolism, I just couldn’t gain weight. Once I started Remeron my sleeping problems went away and I gained 20 pounds. I will say this though to the side effect of weight gain, if you aren’t trying to gain weight it’s probably hard to combat that. Overall I think it’s pretty tolerable in terms of side effects.

  • Nan

    Mirtazipine makes some people feel anxious and it is reported that it “manufactures” depression for some.
    Akathesia is a big side effect. Google this because it isnot in the labeling.

  • Vishal

    Hi , myself 29 years old 3 years back due to sleep issues consulted a neurologist and was prescribed Clonazepam and I am taking 0.5 from then with 10 mg Escitalopram, recently 15 days back my doctor prescribed me Mirtazapine , it makes me so tired …I sleep well for 6 hours but I’m getting terrible acne on my face. I use to get acne now n then but very less …from last 15 days my acne increased a lot can mirtazapine cause acne.? Also it’s making my mood swings a lot but as Clonazepam is not good for long term use as my doc says…..but the side of Mirtazapine is terrible …. anyone needs facing same issues with mirtazapine??

  • Cindy Pearsall

    How do I get a genome test consultation? I’ve had the 23andMe test done.

    1. Nattha Wannissorn, PhD

      Get SelfDecode and upload your 23andme raw data to it, then book a consult on selfhacked.com/contact.

  • steve

    Tryptophan just made me feel weird so I stopped taking it, didn’t help me sleep either
    I think I’m going to try that Fisher Wallace Device instead of trying another drug.
    I’ll stop the Remeron afterwards

  • steve

    To be honest, it stopped being sedating a long time ago and wasn’t sedating at 7.5mg either.
    I kind of figured it wasn’t doing much depression wise but I thought I’d keep it in my system in case I wanted to up the dosage later on, which probably wasn’t a good idea since when I upped it to 15 mg a month ago I didn’t feel right.
    Tried one capsule of tryptophan at bedtime. Funny thing is I was feeling pretty good for some reason before hand, may be due to a supplement I started taking (folate, crucera, Life Extension probiotic?).
    Then I had trouble sleeping and didn’t feel so great this morning. I guess I’ll have to try the tryptophan again and see what happens

    1. Luke Matthews

      Talk to your prescriber.

      Like I mentioned, there should be zero risks of serotonin syndrome with the combination.

      But if being treated by a physician and being prescribed such a low dose and having no benefits in any way shape or form, then there’s no reason for you to be on the medication.

      Rather you should switch medications, or come off it completely and look towards more natural/alternative routes is something you have to decide yourself.

      I’m not a doctor and cannot give you anything more than my personal advice.

  • Steve

    I took Remeron 10 years ago when after a move I got seriously depressed and anxious with worry about finding a job and whether my mother would like where we moved her to.
    I took 15 mg at bedtime and the sleep was great. I also started feeling better within 2 days and my social anxiety improved and depression cleared up. It basically made me very flat so I didn’t care about anything which made it easier to find a job.
    I have been on it pretty much ever since but reduced the dose way down to 3.75Mg because one problem with the drug is that it eventually makes my IBS worse. First reduced it to 7.5Mg then when the IBS acted up, reduced it to 3.75mg.
    I did gain weight and couldn’t get it off until my current bout with depression. Lost my job and got really stressed out, figured I’d up the dose back to 15Mg and all would be well.
    Nope, it didn’t work this time. I was really bummed out.
    So, I am having signs of serotonin deficiency and just bought Tryptophan. I assume it will be OK to take one capsule along with the 3.75mg of Remeron since it’s such a tiny dose.
    I tried Rhodiola but it sometimes helps, sometimes doesn’t. I tried St. John’s Wort but it gives me gas.
    I’m also trying some psychobiotics with not much results.
    I tried the helveticus/b. longum combo from life extension and will try Pure Encapsulations Probiomood sticks next.
    I also tried BioGaia Protectis (l. Reuteri) with no real results. I then found out that their Gastrus product is more specific to anxiety and social anxiety so I will try that next.
    Even more interesting is a device from Fischer-Wallace that is supposed to stimulate the brain to produce more serotonin and I believe dopamime. It is $699 but if it works it’s worth it, IMO

    1. Luke Matthews

      While things like the Fischer-Wallace have FDA approval, from what I’ve seen people have very mixed opinions about it.

      In regards to your mirtazapine dosage, 3.75 is not a therapeutic dosage for depression. While I can not in good conscious recommend you mix serotonin increasing supplements with mirtazapine, I do not see any real risk of serotonin syndrome at your current dosage. 15mg is the lowest therapeutic dosage for depression, and 45mg is the maximum. The lower your dosage the more sedating it is.

      Mirtazapine is more activating at dosages around 30mg, and you’re really not benefiting your depression by taking a dosage as low as you are. Quite the contrary in my experience, a dosage as low as that would cause me to have trouble getting out of bed. If you have more side effects than benefits at a therapeutic dosage, I would recommend you talking to your doctor about different options.

  • TCJUDI

    Luke – thanks for that input. I would like to get off the clonazepam, but I will need something for sleep in the interim 6 weeks or so of misery I would have without the clonazepam. I have taken it for 20 years and have unsuccessfully tried to give it up several times. Ambien is not an option – I sleep, but after about 2 days I start feeling crazy and pressured, just miserable and frustrated. Without the clonazepam, my brain never shuts down. Psych doc once labelled me as BiPolar II, as SSRIs alone make me manic (but Symbyax, olanzapine & fluoxetine, worked for sleep. But put weight on). Any suggestions appreciated!

    1. Luke Matthews

      Look up something called the Ashton Taper Manual, it is the #1 recommendation for getting off benzodiazepines. It will not be easy, especially with the time you’ve spent on them. Taper SLOWLY. Request to be switched to diazepam in order to successfully complete the Ashton taper manual.

      http://www.benzo.org.uk/manual/

  • Xavier

    Well written article joe. Very informative and helps a lot to know more about a medication i was personally recently prescribed and very informative. I appreciate that the writing was able to make it easy to read for someone that doesn’t really know much about things like this.

  • Francisco Aglairton

    Dr. Ken Gillman, Australian psychopharmacologist and the creator of psychotropiccentral, is a great mirtazapine skeptic. Two links worth reading: [psychotropiccentral]

    My experience. It helped with sleep problems and depression (taken with pristiq). The problema: within 18 months I gained 25lbs. Had to taper it off (do it only under medical supervision).

  • Mimi

    I have had some experience w Remeron. All of this is correct. For those sensitive to SSRi it is a definite alternative. It was used after a rage outburst on a temporary basis and definitely helped the person. I knew of a heart surgeon who put a lot of his patients on it rather than refer to Psychiatrist. Not smart! Weight gain and sexual side efffects are the bain of Psychiatrist’s existence.
    Mimi

    1. Luke Matthews

      Hi, yeah weight gain is a common side effect on Mirtazapine.

      It is actually prescribed as an off-label appetite stimulant, and it can make you pretty voracious, craving carbs in particular.

      The general theories that are agreed on are the effect on Leptin/TNF systems, and or the histamine effects.

      If you are on an antidepressant though, you kind of need to ask yourself what is more important, weight gain or the relief of your depression?

  • tcjudi

    I have been taking 0.25mg clonazepam (1/2 0.5mg tab) for sleep at bedtime for years. At this low dose, it doesn’t seem to have any side effects. But if I stop taking it for a few days I have a lot more general aches and pain, so it must be a subtle help for that also. Docs don’t like to prescribe it since it is a benzo, but they do for me since it is such a low dose.

    1. daz

      Perhaps the clonazepam results in you getting more slow wave sleep…
      Which is when all your ‘aches and pains’ get repaired (I think).

    2. Luke Matthews

      Hi! Luke – writer here,
      Benzodiazepines are a very dangerous route and are not generally suggested to be prescribed for more than 4 weeks, Depending on the length of your use, regardless of you being on the lowest dosage possible, what you might be feeling is mild withdrawals due to not taking your clonazepam for a few days. If you think you can manage without clonazepam, you are already on the lowest dosage, so I don’t think the valium taper would be necessary, but please consult with your doctor and see about weaning off them, even at the lowest dosage possible cold turkey is not recommended depending on the length of your usage.

  • Jenssen

    i have a personal hate towards this drug. out of the 200 or so meds i have done in my life, this is one of the worst for all conditions indicated. i agree with the writer’s bad experience on this one, mine was exactly the same but doubled in strength. this drug in particular, has a long history of really bad side effect hence why its not popular and nobody really cares for it in modern times. i got it prescribed in a 3rd world country, that says a lot right there!
    DO NOT DO IT.

    1. daz

      thx for the feedback.
      I did some googling after I posted my comments about possibly using it to help sleep,
      The consensus is basically the same as yours…do not do it

    2. Luke Matthews

      The writer here, I understand that you had a bad experience and so did I but each and every person is different and some could actually find relief from this drug.. this is a prescription medication and should be worked with under a doctor’s supervision. Our differences may be similar and yours may be more intense than mine, but a doctor is prescribing a medication for a reason, and if he thinks you should have tried it, there was a reason he felt the need to prescribe it. You must let your doctor know when you are reacting badly to a medication as soon as possible. The side effects compared to SSRIs are actually minimal The only problem is the sleepiness and weight gain really, and if someone else uses the medication and doesn’t have that problem, then it would be a proper medication for them. Please don’t tell anyone to ever not use something based anecdotal experience, because there are 7 billion people in the world, and not one of us have the same exact brain. You say you have been on many medications especially with SSRIS it takes quite a while before it does its job. Have you ever considered a genome test done? They are very simple and can be done at a doctor or online. Joe offers genome test consultations that will help you find a medication to better suit your needs that you can discuss with your doctor

  • daz

    …on the sleep note,
    Anyone tried low dose Mirtazapine to improve sleep ?
    What did you do, & how did it go…

    1. Luke Matthews

      I have personally not used it myself for sleep because I felt pretty sleepy on the normal dosage. But, my grandpa was prescribed it at a half tablet of 15mg, for sleep after his heart attack because he was having trouble getting to and staying asleep, and it knocked him out very fast. The reason behind this effect is due to Mirtazapine’s histamine effects being STRONGER the LOWER the dosage is. Think about Benadryl, have you ever tried Benadryl and gotten very sleepy? Imagine that but stronger, that is what a low dosage of mirtazapine would feel like.

  • daz

    Thanks for the post Joe.

    I will have a look into the ~ 7.5mg dose for insomnia/improving sleep.

    & speak with my Doc at next visit.

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