Mirtazapine (sometimes also marketed as Mirtazapine or under the trade name “Miro") is one of the most well-known and commonly used antidepressants today. Many people take mirtazapine as part of a treatment for depression, anxiety, and sometimes also as a solution for sleep problems. On the one hand, this drug is known for its ability to relieve symptoms of depression and improve emotional quality; on the other hand, it may affect weight, appetite, and alertness. In the comprehensive guide before you, we will delve into all relevant aspects: from the mechanism of action of mirtazapine, through common side effects, to important guidelines for proper use and gradual discontinuation (withdrawal). If you have asked yourself "Does mirtazapine make you fat?" or "Is mirtazapine addictive?", here you will find all the answers.
What is Mirtazapine (Mirtazapine)?
An antidepressant drug belonging to the tetracyclic family.
Mirtazapine is an active ingredient in the tetracyclic antidepressant class. However, in many sources you will see it listed as an alpha-2 receptor inhibitor (α2 antagonist). It does not work exactly like the older tricyclic drugs (such as amitriptyline), but rather affects unique mechanisms in the brain related to the secretion of serotonin and norepinephrine.
Mechanism of action: Effect on serotonin and norepinephrine
To understand what mirtazapine is, it is useful to know how it works in the brain. The drug blocks α2 receptors, which are responsible for inhibiting the release of norepinephrine and serotonin. As a result, the level of these two neurotransmitters in the synapse increases, which helps improve mood. In addition, mirtazapine blocks serotonin 5-HT2 and 5-HT3 receptors, thereby reducing side effects such as nausea and anxiety. Therefore, many find it a relatively safe alternative to other medications for the treatment of depression.
Miro as a trade name
In Israel, one of the common trade names for mirtazapine is “Miro.” You will sometimes hear doctors and professionals use the terms “mirtazapine” and “Miro” in the same breath, but they are actually the same active ingredient, simply under a different trade name.
What is mirtazapine used for?
Treatment of major depression
Mirtazapine is primarily used to treat major depression. Many patients report relief from symptoms of depression, such as deep sadness, feelings of emptiness, loss of pleasure or interest in daily activities, and sleep disturbances. Mirtazapine is also considered effective in cases of resistant depression, when other treatments (such as SSRIs) have not achieved the desired results.
Treatment of sleep problems (especially at low doses)
Mirtazapine for sleep is a topic that concerns doctors and patients alike. At low doses, mirtazapine is known to affect histaminergic (H1) receptors and cause mild drowsiness. This drowsiness can provide relief to people who suffer from insomnia and difficulty falling asleep. Therefore, many doctors also choose it as a treatment for sleep problems when there is a component of depression or anxiety.
Anxiety treatment (in some cases)
Mirtazapine may also help reduce anxiety (mirtazapine for anxiety). It causes general sedation and can thus relieve mental stress. Sometimes, psychiatrists combine it with other medications to treat various anxiety disorders, although the experience is very individual.
To improve appetite and weight gain
One of the unique features of mirtazapine is its effect on appetite. Many patients report weight gain and increased appetite (mirtazapine weight gain). In some cases, this is actually desirable – for example, in people who suffer from low body weight or loss of appetite due to depression. But for others, it is a less desirable side effect.
Dosages and instructions for taking
Common dosages
Mirtazapine dosage usually ranges from 15 mg to 45 mg. Tablets containing mirtazapine usually come in 15 mg, 30 mg, or 45 mg packages.
- Starting dose: Usually 15 mg before bedtime.
- Maximum dose: May reach 45 mg per day, as directed by your doctor.
Some patients respond well to the low dose, while others need a higher dose to achieve the full antidepressant effect.
How and when to take the medicine
Many people wonder if mirtazapine makes you sleepy (Does mirtazapine make you sleepy?). Indeed, it causes drowsiness and fatigue, especially at the beginning of treatment and especially at low doses. Therefore, the common guideline is to take mirtazapine before bedtime, in order to take advantage of its sedative effect instead of interfering with functioning during active hours.
How long does it take for mirtazapine to take effect?
The numbing effect may appear within the first few days of treatment. However, with regard to improving mood and reducing feelings of depression, it usually takes several weeks (up to 4–6 weeks) to see a significant change. However, quite a few patients feel some improvement within the first two weeks.
How long does mirtazapine take effect during the day?
Mirtazapine's half-life is usually around 20–40 hours. This means that the drug can remain in the system for a considerable period of time. Therefore, even if you take your dose before bed, some of the effect may accompany you the next day, especially if it is at the beginning of treatment and the body has not yet adapted. Many people experience fatigue (mirtazapine fatigue) during the day as well, although this phenomenon tends to decrease over time.
Side effects of mirtazapine
Effect on weight – does mirtazapine make you fat?
The question “Does mirtazapine make you fat?” comes up again and again, and rightly so. Mirtazapine weight gain is a well-known side effect, caused, among other things, by blocking histamine receptors in the body and by an increasing effect on appetite. Not all patients will experience a dramatic increase in weight, but in many cases a significant change is seen. It is important to understand that for certain patients who suffer from a lack of appetite, this is a positive phenomenon that allows their weight to be restored. On the other hand, those who come for treatment with a normal or excess weight are required to monitor their diet and physical activity, and sometimes even to choose an alternative medication.
Drowsiness and fatigue
In the list of mirtazapine side effects, drowsiness appears in a particularly prominent place. At the beginning of treatment, quite a few people experience significant fatigue, both in the evening and the next morning. Some patients see this as an advantage, especially if they suffer from sleep difficulties. Others feel that it limits their daily functioning. In most cases, the body adapts within a few weeks, and fatigue decreases.
Additional side effects
- Dry mouth: A common phenomenon caused by the mild anticholinergic effects of the drug.
- dizziness: Sometimes accompanied by a feeling of fogginess or instability.
- constipation: Can occur as a result of changes in bowel activity.
- Stomach pain: In a small number of cases, people report abdominal discomfort or abdominal pain (mirtazapine abdominal pain).
- Changes in alertness: Some people find it difficult to concentrate, especially in the early stages.
Long-term side effects
Many people are concerned about the long-term side effects of mirtazapine. In general, the drug is considered relatively safe for long-term use. However, those who continue to take mirtazapine over time may experience persistent weight gain, fluctuations in appetite, or mild chronic fatigue. To avoid worsening these conditions, it is important to work with your doctor and monitor physical and emotional indicators.
Mirtazapine addiction and withdrawal
Is mirtazapine addictive?
Is Mirtazapine addictive (Is Mirtazapine addictive)? In the classic sense of physiological addiction (like benzodiazepines or opiates), Mirtazapine is not considered addictive. However, there are possible withdrawal symptoms if the drug is stopped suddenly or unintentionally. Therefore, the question is not “Is Mirtazapine addictive?” but more “Can withdrawal symptoms occur?” The answer is yes, stopping Mirtazapine suddenly may cause symptoms such as insomnia, anxiety, and dizziness.
Mirtazapine withdrawal symptoms
Mirtazapine withdrawal symptoms sometimes include:
- Recurrent (or more severe) insomnia.
- Increased anxiety or restlessness.
- Nausea and stomach pain.
- Dizziness or general weakness.
These are only possible symptoms, and not everyone who stops treatment will experience them. To minimize the risk of these reactions, it is recommended to discontinue mirtazapine gradually (discontinue).
The importance of a gradual cessation
When it comes to stopping mirtazapine (mirtazapine withdrawal), experts recommend a slow reduction in dosage (for example, going from 45 mg to 30 mg, then to 15 mg, and then to 7.5 mg – if suitable tablets are available or tablets can be divided) over a period of several weeks. This approach allows the body to adapt to the changes in the nervous system and prevents a “shock” that could lead to withdrawal symptoms.
Interactions with other drugs and alcohol
Mirtazapine and alcohol
Although there is no absolute prohibition against drinking alcohol while taking mirtazapine, it should be taken into account that the combination may increase drowsiness and depress the central nervous system. Therefore, many recommend avoiding alcohol consumption or at least limiting it during treatment.
Combination with central nervous system depressant drugs
Mirtazapine may increase the sedative effects of other medications (such as benzodiazepines or certain sleeping pills). The combination can be beneficial if taken under close medical supervision, but may also increase the risk of increased fatigue and impaired alertness.
Combination with SSRI and serotonin syndrome
Serotonin Syndrome is a rare but serious condition that can occur when several medications that affect serotonin levels are combined. Although mirtazapine works in a slightly different way, it is important to tell your doctor about any other medications you are taking (including other antidepressants, such as SSRIs or SNRIs). If you experience unusual symptoms such as high fever, shivering, rapid heartbeat, and changes in blood pressure, seek emergency medical attention.
Comparison with other drugs
Cipralex (Citalopram/Escitalopram)
People are sometimes curious about the difference between mirtazapine vs citalopram. While Escitalopram is known to be from the SSRI family, Mirtazapine belongs to a different family and acts on α2 receptors. Cipralex Considered a first-line drug For the treatment of depression and anxiety, but it may cause sexual problems and increased anxiety at the beginning of treatment. Mirtazapine, on the other hand, causes fewer sexual problems but may lead to weight gain.
Trazodone
Sometimes the question arises about mirtazapine vs. Trazodone (mirtazapine vs trazodone). Both drugs have a positive effect on sleep: trazodone blocks certain serotonin receptors and may cause drowsiness, but it is less known to cause significant weight gain than mirtazapine. The choice between the two depends on the patient's characteristics, medical history, and physician preference.
Sertraline (Zoloft / Lustral) – Quick Comparison
mirtazapine vs sertraline (e.g. Zoloft / Lustral): Sertraline is an SSRI, and has a typical side effect profile (sometimes decreased libido, nausea). Mirtazapine may be preferable for those with significant insomnia and loss of appetite, compared to sertraline, which is not known to strongly affect sleep. Each drug has advantages and disadvantages, so the choice depends on the main symptoms.
Frequently Asked Questions (FAQ)
Below are common questions that arise from patients or family members when dealing with mirtazapine treatment:
1. Does mirtazapine make you fat?
Mirtazapine Obesity is a common side effect. Yes, mirtazapine may cause an increase in appetite and weight, especially in the first few weeks of treatment. Not everyone will gain weight at the same rate. Some people will experience a gain of a few pounds, while others will not feel a significant change.
2. Is mirtazapine addictive?
Not in the way that drugs like benzodiazepines or opiate painkillers are known. Mirtazapine does not cause classic “addiction,” but mild physiological dependence may occur. For this reason, it is recommended to discontinue it gradually to avoid withdrawal symptoms.
3. Does mirtazapine cause drowsiness?
Yes, especially at low doses (15–30 mg), mirtazapine causes drowsiness and confusion. That is why it is also commonly used as a treatment for sleep problems and insomnia associated with depression.
4. Is mirtazapine dangerous?
At the usual dose and according to medical guidelines, mirtazapine is considered relatively safe. However, like any other medication, there is a risk of side effects and unwanted symptoms. It is important to consult a doctor and be monitored, especially if there are underlying diseases or taking other medications that may interact.
5. What is the approach regarding mirtazapine during pregnancy and breastfeeding?
It is recommended to consult with your gynecologist or treating psychiatrist. There are not enough long-term studies to declare complete safety in pregnancy, so each case must be examined on its own merits. During breastfeeding, the drug may pass into breast milk in certain amounts, so it is important to assess the risk versus benefit.
6. How long does mirtazapine take to work?
After taking mirtazapine in the evening, its sedative effect may persist into the next morning, but the body usually adjusts later in the day. The full antidepressant effect can be felt after several weeks of continuous treatment.
7. What is the cost of Mirtazapine? (Mirtzapine price)
The drug is available in various health insurance plans, and under certain conditions is subsidized. The price of mirtazapine may vary depending on the drug basket, the type of health insurance plan, and supplementary insurance. In most cases, the drug is considered relatively affordable.
8. How should mirtazapine be stored?
Like most medications, it should be stored in a cool, dry place, out of the reach of children. It is recommended to read the leaflet attached to the package and observe proper storage conditions.
9. What to do in case of overdose (mirtazapine overdose)?
Overdosing on mirtazapine (or any other medication) requires immediate medical attention. Possible symptoms include extreme drowsiness, confusion, and a fast or irregular heartbeat. If you suspect a mirtazapine overdose, it is recommended that you contact an emergency room or go to the emergency room.
10. Can children take mirtazapine?
The use of mirtazapine in children or adolescents is less common, and is usually only considered in special cases. If the drug is recommended by a specialist, side effects and emotional and behavioral changes must be closely monitored.
Recommended external links
- Mayo Clinic – Mirtazapine
On the Mayo Clinic website you can find up-to-date and reliable information about prescription drugs, including details on the mechanism of action of mirtazapine, side effects, and precautions. - Mirtazapine (Remeron) – Uses, Side Effects, and More – WebMD
WebMD has comprehensive information about mirtazapine, including possible side effects, dosage guidelines, and interactions with other medications.
Summary
Mirtazapine (Mirtazapine / Miro) is an effective antidepressant medication that is useful in a variety of conditions: from major depression to anxiety to sleep difficulties. Its mechanism of action is based on α2 receptor inhibition, and a significant improvement in serotonin and noradrenaline levels in the brain. The most common side effects include obesity, fatigue, dry mouth, and dizziness. On the other hand, many report improvement in sleep problems and improved appetite in underweight situations.
Proper dosage planning, consistent use before bedtime, and gradual tapering when discontinuing treatment can help achieve good results and avoid severe withdrawal symptoms. It is important to remember that any use of the drug must be done under the supervision of a physician, especially when combined with other medications or in special medical situations such as pregnancy and breastfeeding.
For many, mirtazapine provides a comprehensive and effective solution to depression and sleep problems. However, as with any drug treatment, it is recommended to maintain close medical monitoring and be attentive to the reactions of the body and mind. If necessary, do not hesitate to seek additional advice or explore other treatment alternatives.
Prof. Leon Greenhouse is a senior psychiatrist with expertise in the neurobiology of depression and anxiety, with over 40 years of experience. He served as a professor at the Hebrew University (Emeritus), Tel Aviv University, and the University of Michigan. He has directed psychiatry departments at leading hospitals in Israel and the US (Sheba, Kfar Shaul, Eitanim, Michigan). He specializes in advanced treatments such as ECT, ketamine, DTMS, and combines psychiatric and neurological approaches to treat PTSD, OCD, schizophrenia, and ADHD. He has published over 150 scientific articles, with approximately 9,000 citations, including groundbreaking studies in the fields of TMS, CBT, and dopaminergic drugs.
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