Mirtazapine is an atypical antidepressant, meaning it does not fit into the classes of other antidepressants. It is often sold as Remeron, among other brand names. When you first start taking it, the antidepressant may require more than four weeks for its full impact to take effect; some benefits may appear within one to two weeks. Often used in cases of depression that are complicated by trouble sleeping or anxiety, some people are at risk of addiction to these pills.
What Is Mirtazapine?
Mirtazapine, classed as a tetracyclic antidepressant, is generally used to treat MDD or major depressive disorder. It also belongs to the class of antidepressant drugs entitled alpha-2 antagonists. Mirtazapine is classified as a specific serotonergic and noradrenergic antidepressant because it is useful in the promotion of the release of serotonin and noradrenaline.
Occasionally, it is prescribed for other issues such as social and generalized anxiety disorders. It is, at this time, uncertain whether this drug is effective and safe in children. This drug works by altering levels of neurotransmitters within the brain, restoring the natural chemical balance inside the central nervous system. Typically, mirtazapine is taken for a span of 40 weeks. Its efficacy was established in the treatment of MDD in 6-week trials of outpatients. An episode of MDD is defined as a relatively persistent and prominent mood of depression or dysphoria interfering with normal daily functioning.
This atypical antidepressant is primarily used to treat major depressive disorder; it has sedative, anxiolytic, antiemetic, and appetite stimulant effects. This explains its off-label use in patients who have insomnia, post-traumatic stress disorder (PTSD), generalized anxiety disorder, headaches, migraines, social anxiety disorder, obsessive-compulsive disorder (OCD), and panic disorder. Clinicians most commonly prescribe mirtazapine when patients have yet to achieve success with other medicines for MDD. It is most often used in individuals with both depression and insomnia or in individuals who are underweight.
Who Can Take Mirtazapine?
Most adults with depression, anxiety disorders, and obsessive-compulsive disorders can take mirtazapine. Many people who take this medication also have difficulties sleeping or staying asleep. Some conditions may become harder to manage while taking this medication, however.
Who Shouldn’t Take Mirtazapine?
Your doctor should always be up-to-date with your medication list and your current medical history. Do not take mirtazapine if you have had allergic reactions to it in the past, have heart problems as mirtazapine can be the cause of low blood pressure, have glaucoma as mirtazapine can increase levels of pressure in your eyes, have epilepsy as this medication can increase the risks of having a seizure, have ever taken other medicines for depression as interference can occur, are pregnant or breastfeeding, or are taking warfarin.
You should also be very careful if you are diabetic and considering taking this antidepressant. Mirtazapine can make achieving stable blood sugar more difficult. If you do take Remeron or one of mirtazapine’s other brand names, be sure to closely monitor your blood sugar over the duration of the first several weeks. Changing your diabetes treatment may become necessary while on this medication.
Other Medical Problems
Other medical problems may, if present, impact the usage of mirtazapine. These problems include angina, which is severe chest pain, or the history of angina; disease of the blood vessels or circulation problems; dehydration; heart attack or the history of heart attacks; heart disease; hypotension, which is low blood pressure; hypovolemia, which is low blood volume; stroke or the history of stroke, which can worsen side effects; bipolar disorder, which is a mood disorder with depression and mania; glaucoma, thee angle-closure type; high cholesterol, also known as hypercholesterolemia, hyponatremia, which is low sodium within the blood; or mania or hypomania and the history of either.
Other potentially interfering problems include a history of seizures, which may worsen with the use of mirtazapine; kidney disease, either moderate or severe; phenylketonuria, which is a metabolic disorder, or liver disease. With the lattermost, the effects of mirtazapine can increase because the body removes it more slowly.
What Side Effects Can Mirtazapine Cause?
Mirtazapine can cause drowsiness, dizziness, increased appetite, dry mouth, weight gain, lightheadedness, or constipation. If these effects appear and become persistent or severe, let your doctor or pharmacist know promptly. Some side effects are considered acceptable as long as the medication is working to treat your depression or other condition that warranted the prescription. These may include:
- Feelings of restlessness
- Thoughts that are racing
- Need for sleep decreasing
- An unusual predilection for taking risks
- Tunnel vision
- Blurred vision
- Being unusually talkative
Serious Side Effects
More serious side effects include:
- Shaking or tremors
- Hands or feet swelling
- Signs of infection such as a lingering sore throat or a fever
Severe Side Effects
Very serious side effects include:
- Severe dizziness
- A heartbeat that is fast or irregular
- Swelling, redness, or pain in the eye or eyes
- Widened pupils
- Vision changes such as rainbows around lights in the darkness
The previous very serious effects call for immediate medical help. Another condition that the increase of serotonin causes is serotonin syndrome or toxicity. The risk is higher if you take other drugs that are responsible for raising levels of serotonin. Get medical help at once if your heartbeat is fast, you have hallucinations, you lose coordination, have severe diarrhea, nausea or vomiting, dizziness, muscle twitches, fever with no explanation, or unusual agitation and restlessness. Do not take mirtazapine together with buspirone, fentanyl, lithium, St. John’s wort, or the pain and migraine medicines tramadol, rizatriptan, and sumatriptan, among others.
This antidepressant can also temporarily reduce the white blood cell numbers within your blood, increasing your chances of developing an infection. If possible, you should avoid those people who have infections. Consult your doctor promptly if you think an infection is developing or if you have chills or fever, sores in your mouth, sore throat, pain in the lower back or side, or difficult, painful urination.
Does Cessation of Mirtazapine Cause Withdrawal?
If you do not wean off from mirtazapine use gradually, you may encounter the symptoms of withdrawal. These include feeling anxious, tingling or numbness in the feet or hands, feeling dizzy, headaches, shaking, and feeling sick. Your doctor, having suggested coming off this antidepressant, will likely advise that you reduce your dose gradually over a period of several weeks or more, depending on how long you have been taking the medication.
Potential Mirtazapine Interactions
Drug interactions may alter how medications function or increase the risk of you experiencing serious side effects. While you should check your product literature and with your medical professional for a complete list of interactions, a few common ones merit mention. MAO inhibitors, when combined with mirtazapine, can cause potentially fatal interactions.
Avoid taking them during treatment or for a timespan lasting two weeks prior to or following treatment with mirtazapine. Also, avoid other medicines that increase serotonin. These range from the street drug MDMA to the herbal supplement St. John’s wort but generally involve other antidepressants such as SSRIs and SNRIs. Your doctor should also know about your use of alcohol, marijuana, antihistamines, medications for anxiety or sleep, muscle relaxants, and opioid pain relievers.
Mirtazapine Overdose Symptoms
Overdoses can be the source of severe health problems, including cardiac arrest, blood pressure that is dangerously low, and seizures. Respiratory depression and death can even occur. The signs of overdose include hallucinations, rapid heartbeat, vomiting, chest pain, trouble breathing, slurred speech, and extreme drowsiness. The risk of overdose increases significantly when other drugs are taken with mirtazapine. Cases of more severe effects, ranging from seizures and serotonin toxicity to comas, have been reported with mirtazapine overdoses.
Addiction to Mirtazapine
Like most antidepressants, Remeron or mirtazapine is considered to be generally non-addictive. If misused, it does not create sensations of being high. Some people do misuse it because of the boost to their mood and the calm feelings it produces. Others may take a larger dose of mirtazapine to counteract stimulant drugs’ effects. Physical dependence may occur, however. Withdrawal symptoms, as previously mentioned, may occur when attempting to cease this medication; this can lead to a cycle of dependence and addiction where individuals can build a tolerance and effectively need more of the medication to prevent those signs of withdrawal. The side effects of mirtazapine may also increase with its misuse. These include drowsiness, weight gain, abdominal pain, diarrhea, vomiting, and suicidal ideation and behaviors.
Most of the people misusing mirtazapine take larger doses of the antidepressant in order to feel its impact more swiftly. Another means of misuse is to combine it with benzodiazepines or alcohol to counteract stimulant effects. As of 2018, roughly 16.9 million Americans of ages 12 and older misused drugs like mirtazapine or other prescription psychotherapeutic drugs at least once over the previous year. This sum is over 6% of the United States population. The best means of preventing the misuse of and addiction to mirtazapine is by following the directions on the prescription, taking the drug precisely as instructed.
Signs of Addiction to Mirtazapine
Symptoms of mirtazapine addiction include taking the drug longer than a doctor prescribes, needing more and more mirtazapine to elicit the right effects, spending most of the day considering the drug and how to get more of it. Other considerations are chasing the effects it produces, being unable to cease taking it, faking symptoms in order to receive new prescriptions, and sudden differences in behavior, physical appearance, and hygiene. Behaviors also include pretending to lose prescriptions and taking the drug without a proper prescription.
How Mirtazapine Helps With Other Addictions
Because of the means by which mirtazapine acts in your body, medical professionals consider it to be useful for treating various addictions. These include alcohol, cocaine, benzodiazepines, marijuana, and opiates. As mentioned, this medicine acts on serotonin. It also affects norepinephrine, which is a stress hormone that originates in the adrenal glands. It helps with the anxiety common in some addictions, like those to opiates and cocaine. Mirtazapine is now a common medication many use in detox treatment facilities, where it medical professionals administer it via injection.
How We Help at Granite Recovery Centers
Our experience, which is the culmination of more than a decade of caring for people with transformative and unique clinical psychotherapies based on evidence, allows us to offer a variety of programs for your well-being. We offer medical detox, intensive outpatient counseling, medication-assisted treatment, and sober living, among others. If you suspect you have a problem with mirtazapine or other substances, you can contact us right away for assistance that is compassionate and effective. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency.