Mirtazapine (Remeron)
Antidepressant (norepinephrine/serotonin receptor antagonist at alpha-2, 5-HT2, 5-HT3; in low dose is histamine antagonist promoting sleep)
- Major Depression3
- Hypnotic safe elderly (and deepens sleep)3
- OCD3
- Methamphetamine2
- Anxious Depression
- Anti-nausea
- Insomnia
Features
Dosing
7.5-15 mg qhs for sleep, 30-45 mg qhs for depression (maximum benefit usually at 30 mg).
INTERACTIONS: Raise by 2-3x if using with carbamazepine.
Management
Reduces cravings in meth/amph (?cocaine) abuse. Reduces side effects of SSRIs, but does not augment antidepressants (except in anxious depression).
Good for anxious depression and geriatrics. Deepens sleep quality.
Treats nausea and itch. Treats akathisia in doses below 30mg/night, but can cause it above that.
TOLERABILITY: fatigue, weight gain (30%).
RISKS: Very rare decreased platelet count.
EMR Text
Depression
Mirtazapine use based on FDA approval in depression.
Mirtazapine side effects reviewed with patient.
Insomnia
Mirtazapine use based on trials in insomnia, where it deepened sleep quality.
Mirtazapine side effects reviewed with patient.
OCD
Mirtazapine use based on a randomized controlled trial in OCD.
Mirtazapine use based on randomized controlled trials in methamphetamine use disorder.
Mirtazapine side effects reviewed with patient.