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> Remeron


US brand name: Remeron
Generic name: mirtazapine

Other Forms: You might be able to get it in pill form. These days Remeron SolTab - the orally disintegrating tablet - is the main way it’s prescribed and dispensed.

Class: Antidepressant. Specifically a Tetracyclic Antidepressant. Even more specifically a noradrenergic and specific serotonergic antidepressant (NaSSA), but is the only one available in the US.

1.  Other brand names & branded generic names1

  • Avanza (Australia)
  • Axit (Australia)
  • Mirtabene (Austria)
  • Remergon (Belgium)
  • Norset (France)
  • Remergil (Germany)
  • Mirtaz (India, Sri Lanka)
  • Rexer (Spain)
  • Zispin SolTab (United Kingdom, Ireland)

2.  FDA Approved Uses

Major depressive disorder

3.  Off-Label Uses

4.  Remeron Pros and Cons

4.1  Pros

  • If serotonin and/or norepinephrine are the answer for you, it will pull you out of the deepest, blackest depression like no other medication will.
  • It may not be as good as Seroquel or Zyprexa for knocking you out, but it’s better than trazodone for the combination of depression and insomnia.

4.2  Cons

  • You may literally eat sugar straight out of the bag to satisfy your cravings for sweet carbohydrates. By “literally” I mean I have received e-mails from, and read reports by, people who have done exactly that.
  • You may sleep too well.
  • Has one of the highest poop-out (tachyphylaxis) rates of any med, antidepressant or otherwise.

5.  Side Effects

5.1  Typical Side Effects

Most of the anticholinergic effects common with psychiatric medications (e.g. constipation, confusion, loss of coordination, memory loss) are infrequent. Instead you get intense hunger for the wrong foods, and with that comes weight gain, dry mouth and constipation caused by what you eat and not the drug itself. Then you want to sleep a lot. It’s like you may as well be smoking pot. Except usually less fun. Although Remeron won’t make your bipolar disorder (or schizophrenia) a lot worse like cannabis will.

5.2  Not So Common Side Effects

Edema, dizziness, low blood pressure, increased thirst to go with the munchies, ‘flu-like symptoms.

5.3  Freaky Rare Side Effects

Going deaf and various flavors of herpes. Yeah, right, it was the Remeron that gave someone that STD. (See this review for how the herpes thing really works.) The deafness (the PI sheet doesn’t indicate to what extent or for how long) is an example of my “side effects are sometimes like allergies” corollary to the “allergies are leftover immune responses to diseases that no longer exist” hypothesis. But only if you consider the case studies referenced above about using Remeron to treat auditory hallucinations. It’s not as strong a connection as the one for the whole-body muscle aches caused by Topamax and Lamictal being related to how well they treat atonic (drop) seizures.

Remeron also carries a warning for agranulyocytosis, the severe reduction in white cell count, along with fever, infection and all that fun stuff. That hit Mouse like a ton of bricks. She was stuck in a motel in Fairfield for a week after one dose.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You

  • Remeron appears to be subject to a really quick poop-out, like after just a month or so. Works great, then quits on you.
  • Remeron will make you more drunk. So while liquor as no effect upon Remeron, the opposite is not true, so be extra careful if you want to have the occasional drink.


7.  Dosage and How to Take Remeron

The initial is 15mg. If no improvement is felt within two weeks, that may be increased to 30mg. If you’re still not feeling better a month after that, you can go up to 45mg and officially that’s it, although there are reports of some psychiatrists experimenting with doses up to 90mg. There are no other published dosage options for Remeron at this time, it’s just weird that way. 15, 30 or 45mg. Some of the more enlightened doctors are starting their patients at 7.5mg and titrating them in 7.5mg increments, and I’m all for that method. If I were you, and I got along with meds that messed with my serotonin, I’d insist on that. 7.5mg to start, up to 15mg after a week or two if no improvement, then 22.5mg after a month and so forth up to 45mg. I think the 90mg craziness is in response to Remeron poop-out, which is just exposing people to side effects for no good reason.

8.  How Long It Takes to Work

  • For depression: one to two weeks.
  • For sleep: usually the night you take your first dose, the second night at the latest. If Remeron doesn’t make you tired at 15mg a night, don’t bother.

9.  How to Stop Taking Remeron

Your doctor should be recommending that you reduce your dosage by 7.5 - 15mg a day every week if you need to stop taking it, if not more slowly than that. Based on the 20–40 hour half-life.

10.  Half-Life & Average Time to Clear Out of Your System

Mirtazapine’s half-life is 20–40 hours. The average is 26 hours for guys and 37 hours for girls. Girls always take longer. So mirtazapine is out of a guy’s system in about five days while it’s out of a girl’s in about seven days.

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream2, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what3, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

11.  Days to Reach a Steady State

Steady state is usually reached in five to seven days.

Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.

12.  Shelf life

3 years.

13.  How Remeron Works

Being the only noradrenergic and specific serotonergic antidepressant (NaSSA) approved for use in the US makes the way it works somewhat unique. In Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Stahl describes the mechanism as stepping on the accelerator and cutting the brakes of norepinephrine and serotonin. I think of it more like having your brain sit in a jacuzzi instead of just marinating tasty brain juices for longer the like SNRIs such as Cymbalta and Effexor] would do. SNRIs aren’t able to target where they work, while mirtazapine can, as it is an agonist at the serotonin 5-HT1A receptors and an antagonist at 5-HT2A, 5-HT2C & 5-HT3. It’s also an extremely potent antihistamine. In English: That’s why it’s a super-effective antidepressant/anti-anxiety med and sleeping pill that can poop-out quickly and literally make you eat sugar right out of the bag.

14.  Comments

At any dosage it will make you crave doughnuts. Seriously. You will want to invest in Krispy Kreme stock (or maybe something along similar lines that isn’t tanking); as Remeron’s antagonism of the serotonin 5HT2C and H1 receptors gives you the munchies for carbohydrates and sugars like you were 16 and smoking the best pot ever in the parking lot of a strip mall with a 24-hour doughnut shop beckoning you with glazed and jelly-filled ecstasy. People dipping spoons into a bag of sugar and eating it as is - not unheard of when on Remeron. This stuff is nothing more than legal marijuana, and if I knew crap about biochemistry I could probably prove that crazy statement. From a purely molecular-chemical perspective THC and mirtazapine are nothing alike. But there’s just something about how the two drugs work that is really close. And people who have self-medicated with pot respond really well to meds that really push the norepinephrine, and hard. Strattera, reboxetine, Cymbalta, and the more potent TCAs. And Remeron.

The production of extra serotonin and norepinephrine, and not just soaking neurons in what neurotransmitters are available for a longer period of time, is sometimes the best solution to recalcitrant depression. When it works it makes people feel really good. I mean really good. This is the closest thing to a happy pill on the market. Until you get all bummed out about how much weight you’ve put on and how little you do because you’re sleeping all the time.
As mirtazapine encourages your brain to actually produce more of the neurotransmitters serotonin and norepinephrine, talk to your doctor about taking their respective precursors, 5-HTP (or l-tryptophan) and l-tyrosine. Neurotransmitter/monoamine depletion is a controversial hypothesis, but it explains too many things, like antidepressant poop-out (tachyphylaxis) to dismiss outright.

This med is not for mild to moderate depression, it’s for people who are seriously depressed, who are willing to put up with the weight gain and the sleeping because those side effects suck much less than the dark pit of depressive despair one finds oneself in.

You probably don’t want to mix Remeron with Zyprexa as your choice of antipsychotic and antidepressant to treat bipolar disorder or severe treatment-resistant depression. One woman I know from the bipolar support forum on about.com was prescribed that combination as an inpatient in a Canadian hospital. She reported there how she ballooned up in weight, from 103 pounds to 162 pounds, in about six weeks, and carrying that on a 5′ 1″ frame. She gained a pound and a half a day, eating hospital food! As has been pointed out, that isn’t possible in this universe. Or at least is extremely unlikely. I have read several reports of people who were on cocktails of Remeron and an antipsychotic for refractory unipolar or bipolar depression. No one had, or will gain half a kilo a day, but rapid and extensive weight gain is as certain as sunrise over a suburban stripmall being accompanied by the scent of doughnuts.
What doctor in their right mind would prescribe Remeron and Zyprexa for someone not in their right mind? It’s not as crazy as it sounds: Combined treatment of olanzapine and mirtazapine in anorexia nervosa associated with major depression, Mirtazapine add-on improves olanzapine effect on negative symptoms of schizophrenia, and Management of symptons associated with advanced cancer: olanzapine and mirtazapine. I’m pretty sure she didn’t have cancer, but the other two uses could explain the perception of gaining a pound and a half a day.


15.  Remeron Ratings, Reviews, & Other Sites of Interest

Remeron Ratings & Reviews Page.

15.1  Rate Remeron

Give your overall impression of Remeron on a scale of 0 to 5. Detailed ratings and reviews are available on the Remeron Ratings & Reviews Page.

Get all critical about Remeron

3.5 stars Rating 3.1 out of 5 from 189 criticisms.
Vote Distribution: 31 – 8 – 13 – 17 – 62 – 58


15.2  Rate this article

If you’re still feeling judgmental as well as just mental4, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Remeron (mirtazapine) Synopsis

4 stars Rates 3.6 out of 5 from 117 value judgments.
Vote Distribution: 9 – 1 – 5 – 2 – 45 – 55


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15.3  Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.


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15.4  Discussion board

If you have any questions not answered here, please see the Crazymeds Remeron discussion board.



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16.  References

  1. Remeron (mirtazapine) Full US Prescribing Information

Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.

Primer of Drug Action 12th edition by Robert M. Julien Ph.D, Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers.

The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition by Stephen Stahl © 2009 Published by Cambridge University Press.

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier. Also the 2004 edition, but only on pages that haven’t been fully updated yet.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond MD © 2002. Published by W.W. Norton

The Complete Guide to Psychiatric Drugs Edward Drummond, MD © 2000. Published by John Wiley & Sons, Inc.

PDR: Physicians’ Desk Reference 2010

Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.

1 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

2 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.

3 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

4 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!


If you have any questions not answered here, please see the Crazymeds Remeron discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


Last modified on Wednesday, 26 March, 2014 at 13:45:42 by SomeMedCriticPage Author Date created
“Remeron (mirtazapine): a Synopsis for the Educated Consumer.” by Jerod Poore is copyright © Jerod Poore Published online 2011/04/25
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Remeron, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2004 - 2014. All rights reserved.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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