mirtazapine

Adjunctive therapy

Brands: Remeron

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

View details

Quick answers

What is mirtazapine?
Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA) approved for major depressive disorder and frequently chosen for patients needing sedation, appetite stimulation, or an augmentation option with low sexual side-effect burden.
What is Remeron?
Remeron is a brand name for mirtazapine.
What is Remeron (mirtazapine) used for?
Label indications include: Major depressive disorder.
What drug class is Remeron (mirtazapine)?
Central presynaptic alpha-2 antagonist; enhances noradrenergic and serotonergic transmission (NaSSA).
What strengths does Remeron (mirtazapine) come in?
Tablets and orally disintegrating tablets: 7.5–45 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Remeron
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-10-05

Label indications

Major depressive disorder.

View labelExact

Clinical Highlights

Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA) approved for major depressive disorder and frequently chosen for patients needing sedation, appetite stimulation, or an augmentation option with low sexual side-effect burden. Despite advantages for insomnia or cachexia, weight gain and metabolic monitoring are central considerations when selecting mirtazapine as monotherapy or adjunct therapy.

The compare tool and the mirtazapine evidence feed can help balance sedation, metabolic risk, and augmentation data when adjusting therapy.
Sedation and weight gain require metabolic monitoring; rare agranulocytosis warrants counseling on infection symptoms.
Sedation is often strongest early (and at lower doses) and may lessen over time; setting expectations helps prevent premature discontinuation.
Major depressive disorder (FDA 1996)
Generic: Generics widely available.

Dosing & Formulations

Tablets and orally disintegrating tablets: 7.5–45 mg. Typical adult initiation: 15 mg at bedtime; increase to 30 mg after 1–2 weeks based on response; usual maintenance 15–45 mg nightly.

Lower doses (7.5–15 mg) can cause more prominent sedation; doses ≥30 mg often provide stronger antidepressant effects with relatively less sedation.
Older adults or patients with renal/hepatic impairment often start 7.5–15 mg nightly with cautious titration; doses may be limited to 30 mg/day in moderate impairment.
Tapering is typically gradual over weeks to avoid cholinergic rebound and discontinuation symptoms.

Monitoring & Risks

Boxed warning: Antidepressants increase suicidality risk in young adults; closer monitoring is common. Somnolence: ≈50%; consistent bedtime dosing is common, and driving precautions are commonly discussed.

Increased appetite/weight gain: BMI, fasting lipids, and glucose are typically monitored at baseline and during therapy.
Dry mouth: Hydration and oral hygiene counseling is common.
Constipation: Fiber, hydration, and stool softeners are commonly discussed when necessary.
Dizziness/orthostasis: Slow positional changes are commonly recommended, especially in older adults.

Drug Interactions

Contraindicated with MAOIs; a 14-day washout is typically used to avoid hypertensive crisis or serotonin syndrome. Additive sedation with alcohol, benzodiazepines, opioids, or other CNS depressants—driving and machinery precautions are commonly discussed.

CYP1A2/2D6/3A4 inhibitors (fluvoxamine, paroxetine, ketoconazole) increase levels; inducers (carbamazepine, phenytoin) lower exposure—dose adjustments are guided by clinical response.
Combined serotonergic agents (SSRIs, SNRIs, linezolid, triptans, tramadol) increase serotonin syndrome risk; combinations are often avoided or monitored closely.

Practice Notes

Good option for depression with insomnia, poor appetite, or sexual dysfunction intolerance; lifestyle strategies to counter metabolic effects are often discussed. Weight/BMI, blood pressure, and fasting lipids/glucose are typically monitored at baseline and periodically during therapy.

Education often covers agranulocytosis warning signs (fever, sore throat) and that these symptoms warrant prompt evaluation.
When augmenting bipolar depression, monitoring for mania/hypomania can be coordinated via the bipolar disorder hub, alongside printable counselling sheets.
Pregnancy planning and breastfeeding are typically discussed; obstetrics coordination is common to weigh benefits versus potential risks.

References

Remeron (mirtazapine) prescribing information — DailyMed (2025)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
Comparative efficacy and acceptability of 21 antidepressant drugs for major depressive disorder — The Lancet (2018)Meta-analysisdepressionefficacy