Remeron (mirtazapine)
uses, side effects, dosage, how to take, how to stop taking, and more

US Brand Name: Remeron

generic name: mirtazapine

Other Forms: You might be able to get it in pill form. These days the disintegrating tablet is the main way Remeron is dispensed.

Class: antidepressants. Specifically a tetracyclic antidepressant.

1.  Other brand names & branded generic names¹

• Avanza, 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 of Remeron (mirtazapine)

Major depressive disorder

3.  Off-Label Uses of Remeron (mirtazapine)

• Panic/Anxiety
• Bipolar Depression
• Sleep Disorders
• Chronic Fatigue
• Fibromyalgia
• Arthritis
• Lupus
• Irritable Bowel Syndrome

4.  Remeron’s (mirtazapine’s) pros and cons

4.1  Pros

If serotonin and/or norepinephrine are the answer for you, Remeron will pull you out of the deepest, blackest depression like no other medication will.

4.2  Cons

You will literally eat sugar straight out of the bag to satisfy your cravings for sweets and carbohydrates.

5.  Remeron’s (mirtazapine’s) 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 with Remeron. 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 Remeron itself. Then you want to sleep a lot. It’s like you may as well be smoking pot when you take Remeron.

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, Remeron gave someone an STD. 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 of Remeron.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You about Remeron (mirtazapine)

• 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. Be extra careful if you mix booze and Remeron.

7.  Remeron’s (mirtazapine’s) Dosage and How to Take Remeron (mirtazapine)

The initial dose of Remeron 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 Remeron (mirtazapine) 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 (mirtazapine)

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.  Remeron’s (mirtazapine’s) Half-Life & Average Time to Clear Out of Your System

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

11.  Days to Reach a Steady State

Usually five to seven days.

12.  How Remeron (mirtazapine) Works

Remeron is a somewhat unique med in the way it works. It directly increases the amount of serotonin your brain produces, and indirectly does the same for norepinephrine. It also speeds up the rate at which those neurotransmitters hit their receptors. Stahl calls that stepping on the accelerator and cutting the brakes. I think of it more like having your brain sit in a jacuzzi instead of marinating for longer like Cymbalta and Effexor would do. Plus Remeron focuses most of the serotonin action on 5TH1A receptors, blocks 5HT2A, 5HT2C & 5HT3, and is a potent antihistamine. In English: That’s why it’s a super-effective antidepressant/antianxiety med and sleeping pill that can poop-out quickly and literally make you eat sugar right out of the bag.

13.  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. Remeron 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 Remeron 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.

Remeron 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.

Just don’t mix Remeron with Zyprexa as your choice of antipsychotic and antidepressant. One woman was recently prescribed that combination as an inpatient in a Canadian hospital. She reported on the bipolar support forum on about.com 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!

14.  Discussion board

Crazy Meds’ Remeron discussion board

15.  Your Comments About and Experiences with Remeron

Tell us what you think about Remeron

Recently I had some kind of episode and was arrested by the police. Fortunately for me they were able to figure out that I was a few sandwiches short of a picnic so they bundled me up into and ambulance and sent me to the phsyc ward.

After a few hours i was able to come to my senses and spoke to a doctor. I was really worried about the diagnosis and thought paranoid schiz was my number. To my relief the doctor thought different and pinned major depression on me instead.

Remeron was his answer in terms of medication. I’m 37 years old and have never been on medication in my life. I’ve had suicidal thoughts since I’ve been 16 but told noone of it, maybe a few people here and there but thought it was something everyone had but just kept it to themselves. I’ve been on a mental diet for years but that only goes so far.

I’ve been on Remeron for about 2 weeks now and haven’t found it to be that affective just yet. The first night I took it, it put me to sleep within 15 minutes. The same happened on the second night. From the third night it has not been as affective although I do feel drowsiness but I can’t fall asleep the way I did on the first couple of nights. Initially the suicidal thoughts got really extreme and I felt engulfed by the darkness but years of mental dieting got me through that part which probably lasted about a week. I’ve always been a big sleeper and big eater but I have put on no weight just yet and the long sleeping hours are normal for me.

I read in an article on this site that Remeron is like smoking really good pot. I have been a on and off again pot smoker for 15 years and I do not find the effects the same or even similar but maybe that’s just me. Also, it claims that you will eat sugar from the bag which is something I have been doing since I was a child so I can’t really comment on that.

I am 6 feet tall and weigh 85kg. After being on Remeron for 2 weeks I’m still the same weight. Also, Remeron has not made me grow any taller :)

I will commet on my progress just in case someone is interested and let those who are interested know if anything wierd happens.

Thanks for reading :)

My experience with mirtazapine (remeron) runs counter to most of what’s written in “13. Comments”… to the extent that I believe those comments should be removed.

I think mirtazapine is difficult to pin down because it’s effects are quite different at different doses. At 15mg it has mainly an antihistamine - it basically just makes you very sleepy. At 30mg the norepinephrine and serotonin effects kick in - you’re still sleepy but you can function a bit. At 45 you get a nice lift in energy, wakefulness, and antidepressant effect.

That’s my experience anyway, and it seems to be backed up by some scientific evidence. Someone posted this link in the remeron forum but I think it’s worth repeating here:

I haven’t gained any weight after a month at 45mg, but I’m having trouble with other side effects - trouble falling asleep, poor quality sleep, restless leg, respiratory depression, dry sinuses, sore throat (just a tickle). Still, I’d say it’s the best antidepressant I’ve tried, and I’ve tried them all - ssri, snri, tricyclic, maoi, tianeptine, antipsychotics, etc. I can’t tolerate the anticholinergic side effects (specifically - weight gain, sexual disfunction, and especially bad bladder problems) of ssri or snri classes - so remeron has been a godsend… so far.

I am 30 years old & have just started my new medicine. My opinion after reading comments is this: It does say that if balance in your brain is what you need than the side effects are what suggested they are. I have started it today but will post update. Those who complain it isn’t working, should maybe get on different medicine that will work. Chances are its not helping because you have a different problem which this medicine is not used ttto treat.

I was on Celexa but the sexual side effects were drastic. So my doc put me on Remeron. On the bonus side- the dreams are amazing and I was remembering quite a good deal of them. on the negative side my motivation for anything apart from stuffing my face with junk food went out the window. It made me a very chilled out type of zombie. I would take the med and struggle to stay up for another half an hour then again struggle to get out of bed. Then on top of that I needed a nap of between 1–2 hours in the middle of the day.

Yet another negative was my reaction with alcohol- I’m not a big drinker these days and I found the desire to drink heavy was quite strong for me- 2 bottles of wine and the next day I felt stoned like I’d had some mild pot- it gave me a crappy unproductive day wearing a stupid expression on my face and and worst of all I had a hair trigger temper- I snapped at my kids so hard that I was shocked.

After a few weeks of this I’ve gone back to Celexa with a side of Zyban.

I should have mentioned that I was on 30mg for about 3 weeks after the 15mg for the first week. I didn’t try the 45 because of the hair trigger temper incident.

I’ve been on Remeron 30 mg (up from 15) for about a month now, which was added to the Effexor XR 225 mg and Oxazepam 30mg I’ve been taking for several years.

First, lemme say that I was expecting the R to zonk me out, especially after everything I’ve read. Can’t say I was looking forward to that as I’ve been living in a haze for the past 15 years. BUT. I haven’t felt sleepy a bit! In fact, I wish it’d had some effect on my ridiculous sleep pattern of 3 1/2 hours a night and then another 2–3 in the afternoon (lucky for me I don’t work a regular job).

For the most part, I feel great! I’ve got a spring in my step and I don’t get snappy. My energy is much higher (and this is saying a lot for someone with depression and CFS/Fibro). I do want to eat the world, though today seems a bit better that way. I think that if you KNOW it’s the drug that’s increasing your appetite, then it’s a bit easier to stop yourself from non-stop bingeing. Assuming you don’t want to gain weight, that is (which I certainly don’t). When I mentioned my hesitations about starting this med to my shrink, he said that the Effexor would help diminish Remeron’s side-effects. Maybe it has.

HOWEVER, I seem to have lost my ability to taste stuff properly. Someone described it as having cotton wool in your mouth and, yeah, it’s kind of like that. Salt, sweet, bitter - everything tastes muted, which is really a drag. Also, the roof of my mouth feels raw, like it’s been burnt by hot food. I also had major cancre sores the first couple of weeks.

Other side effects are constipation and flatulence, though perhaps those are partly due to the extra carbs I’ve been eating. I’ve been cooking and baking like a maniac, but then I’ve also been more active. I may have gained about a pound but I feel that, so far, it’s under control.

Anyhow, I don’t know what Remeron on its own would be like but as a supplement to Effexor, for me, it’s working. And my family is getting home-made cake.

I’m 37 years old and my issues are many, but are primarily manifested via insomnia and anxiety, all mixed up together, multiplying each other. remeron is the only thing i’ve tried that fixes those issues. at first the ability to sleep on a regular basis seemed like enough to cure me, but after a few weeks i noticed that i wasn’t even having the anxious days/nights that would previously have caused me to have insomnia. without remeron if i am even asleep when the alarm goes off i am up in 2 seconds because of constant low level anxiety even at 5 in the morning. with remeron i am out so hard all night that i have to use some serious energy to drag myself out of bed at normal time. however, once i’m up for 10 mins or so i am feeling just fine. if i let myself lay there in the fog i could do that for hours probably, but i’d rather be up and functional. another plus - since i am still in that half-fog while getting ready in the morning i get a lot of those solutions to problems i had the day before popping into my head. i keep a pad of paper in my bathroom so while i am doing my morning routine i can jot down things that have just literally popposed into my head that i can implement later in the day. they are like little gifts. i already don’t think normal, but this is a positive. I’m completely functional during the day. very stressful job, but have been realizing at odd moments that i am not anxious during moments that i would have been a few months ago. it feels freeing. what normal people must have been feeling all along. so i love remeron. unfortunately, remeron doesn’t love me - It loves food. it thinks about food all day long. i went through the phase of allowing myself to eat everything remeron wanted, and then gained 10 pounds. Then i put a stop to it. now, i make remeron use the treadmill as often as possible, lost the 10 pounds, but struggle on an hourly basis to not eat. I’m doing pretty good while at work. i only eat what i take, but damn i never realized how much we celebrate with food at work. the other day someone brought in a cake for himself because he had been there a year. Really??? it is a challenge everyday to walk by the cake and the cookies and the bagels and pass them all up. the trick is - don’t even take a bite. anyway, now you see where i am at with remeron, happy, not anxious, but obsessed with food. It’s worth it. oh, one other gripe. my obgyn put me on the pill and that wreaks havoc with all of it. brings into your happy world irritability, sadness, feelings of hopelessness, etc. no wonder we need antidepressants! i am so miserable that i have to take a sleeping pill to get my mind off it all and when i do that i don’t like to take the remeron. I’m going to fix this tomorrow by talking to my OBGYN and getting off the pill.

Enter your own Comments & Experiences with Remeron here.
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16.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Remeron Full US Prescribing Information / PI Sheet

Check for drug-drug interactions

17.  Bibliography

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.

Date created 25 Apr 2011 - 12:42 Page Author: JerodPoore Last edited by: JerodPoore

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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 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]