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Remeron (Mirtazapine) Side Effects, Withdrawal and FAQs

Remeron (mirtazapine) is a tetracyclic atypical antidepressant medication used in the treatment of depression and other off-label uses in adults 18 and older.
Remeron is not approved for patients under age 18 due to increased suicidal thoughts, as stated on the package’s Black Box warning.
The patent on Remeron (mirtazapine) expired in 2004. Since then, many other brand name versions have been developed and marketed including Reflex, Mirtin, Tetrazic, Zestat, Zispin, Pharmataz, Miro, Ramure, Calixa, and dozens of others.

Side effects for this antidepressant are similar to many other antidepressant medications, and may present as mild, moderate or severe and potentially life-threatening.

Withdrawal can also cause adverse effects, and the FDA and other regulatory bodies stipulate that this drug should never be stopped abruptly. A slow taper is recommended as this allows time for the body to adjust in a more gentle fashion.

We will cover some of the most types of frequently asked for information below. Always consult your primary caregiver for specific concerns about taking Remeron, reactions to the drug that seem unusual or make you feel uncomfortable.  We can also provide more information on request.

What is Remeron (Mirtazapine) Used For?

Remeron (mirtazapine) was approved primarily for the treatment of MDD or major depressive disorder. MDD symptoms are described in the DSM V, and include these diagnostic criteria:

  1. symptoms should not be included that are clearly attributable to another medical or pathological condition, and
  2. the physiological effects of a substance are not attributable to the depressive episode.

As stated, before diagnosing a person with MDD, at least the 2 above elements (along with other diagnostic criteria) must be verified. (1)

It would follow that adequate testing, and investigation would have to be done to rule out these potential root causes for a depressed condition before attempting to medicate the patient.

Such investigations would have to include at a minimum, testing for nutritional deficiencies, environmental toxins, food or other allergies, the presence of neurotoxic elements like heavy metals, pathologies, drug use, addiction or dependence, and many other potential agents or influences or substances known to be causal agents in depressed states.

Remeron has also come to be prescribed for many off-label uses, such as:

PTSD (post traumatic stress disorder): In diagnosing PTSD disorders, some qualifying symptoms listed in the DSM V have been revised, for example in “Criterion A” the scope of the diagnosis was significantly narrowed. The diagnostic criteria no longer include the unexpected death of a family member or close friend, for example, who died of natural causes.

Emotional disorders: The most recent DSM V has now collapsed multiple types of disorders into one over-arching category which it refers to as “emotional disorders”.   Emotional disorders, as a group, include the various bipolar disorders, the “distress disorders” which include major depression disorder, generalized anxiety disorder, panic disorder, PTSD, and the “fear disorders” which are the phobias, i.e., social phobia, agoraphobia, etc.  (2)

Other off-label uses: including for insomnia (3), itching, nausea and tension headache (4), and as an appetite stimulant (5).

IMPORTANT NOTE:

As antidepressants are often used in conjunction with multiple medications and electroshock therapy to treat psychiatrically diagnosed conditions, it should be noted that the DSM V diagnostic criteria changes apply to adults as well as to adolescents and children. (6)

Remeron (Mirtazapine) Alternative Names and Slang

As discussed earlier, there are a substantial number of names for mirtazapine around the world. When mirtazapine is combined with velaxafine it is sometimes called “California Rocket Fuel”, indicating recreational use.

Remeron (Mirtazapine) Side Effects

There can be a wide range of side effects experienced while taking mirtazapine or Remeron.

Common REMERON Side Effects can include:

  • Sedation (can be severe)
  • Depression
  • Worsened depression
  • Suicidal thoughts or behavior (FDA recommends monitoring the patient for emerging suicidal thoughts or behavior (7)
  • Tremor
  • Convulsions
  • Swelling (tongue, lips, or other parts of the body)
  • Vertigo (spinning sensation, loss of balance, whirling feeling)
  • Flu-like symptoms (sore throat, fever, cough, etc.)
  • Ulcers (in mouth or other mucous tissues)
  • Abdominal pain
  • Back pain
  • Muscle pain
  • Low blood pressure
  • Vomiting
  • Weakness
  • Stupor (loss of consciousness, appears drunken)
  • Ataxia (loss of full control of body motions)
  • Akasthisia (distressed, agitated state of restlessness and compulsive motion caused by antidepressants and other medication)
  • Restless legs
  • Dementia
  • Loss of taste or perversion of sense of taste
  • Gum hemorrhage
  • Intestinal bleeding
  • Intestinal obstruction
  • Dyspepsia (indigestion)
  • Hot flashes
  • Decreased libido
  • Skin rash
  • Short of breath
  • Mental changes (confusion, anger, dispassionate, anxiety, irritability, etc.)
  • Edgy
  • Agitation
  • Twitching
  • Unusual dreams
  • Interrupted sleep
  • Drowsy, tiredness
  • Dizziness
  • Elevated mood
  • Euphoria
  • Adhedonia (inability to feel pleasure, lack of usual or natural pleasurable emotional response)
  • Increased appetite
  • Cravings (carbohydrates or junk food)
  • Weight gain
  • Constipation
  • Xerostomia (dry mouth)
  • Menstrual pain
  • Changes in vision
  • Enlarged salivary glands
  • Excess salivation
  • Drooling
  • Gastritis (inflammation of the stomach lining)
  • Pancreatitis (inflammation of the pancreas)
  • Mania (presents as exaggerated self esteem, decreased need for sleep, racing thoughts, impulsive behavior without regard for consequences, i.e., excessive shopping sprees, flight of expansive or delusional thoughts, etc.)

Remeron (Mirtazapine) Withdrawal Symptoms

Withdrawal effects during cessation should be observed carefully, even at a slow taper, as these include some potentially life-threatening events.

Withdrawal symptoms from Remeron include:

  • Mania
  • Suicidal thinking
  • Thoughts of harming self
  • Negative self-talk
  • Tremors
  • Shaking
  • Disturbed sleep
  • Hypomania (a less severe form of mania-like symptoms)
  • Nausea, vomiting
  • Decrease in appetite
  • Increased tiredness
  • Fatigue
  • Flue-like symptoms
  • Crying spells
  • Confusion
  • Depression
  • Depersonalization
  • Allergies
  • Mood swings
  • Irritability
  • Sweating
  • Headache
  • Prickling skin sensations
  • Irritability
  • Dizziness
  • Nightmares

Discontinuing/Quitting Remeron (Mirtazapine)

Talk to a trusted healthcare practitioner who can help you devise and implement a structured, safe plan for withdrawal over a period of time. Never attempt a “cold turkey” approach to coming off antidepressants of any type.

Staying hydrated, getting enough rest, eating well are some of the things you can do to help the process along without getting extremely sick.

Remeron (Mirtazapine) FAQs

Remeron has been around since the late 1990’s. Over time, a fairly substantial body of information has been able to accumulate on the drug. Here are some of the topics and questions that are often searched for.

Is Mirtazapine a Narcotic?

Mirtazapine is a tetracyclic atypical antidepressant, but is not conventionally defined as a narcotic. It can have some narcotic effects; a narcotic is defined as a substance that affects mood or behavior. There is often a connotation of illegality when the word narcotic is used, which legal overtones do not typically apply to mirtazapine.

How Does Mirtazapine Work?

It is not known how mirtazapine works exactly or how it treats depression in the brain. Since it has effects on the release and receptivity of both noradrenaline and serotonin as defined by the manufacturer’s pharmacodynamics profile, its overall effects may demonstrate similar to an SNRI even though the mechanisms of action does not involve neurotransmitter reuptake. Remeron is also believed to have an antihistaminic effect that is thought to be associated with its observed capacity to stimulate. Based upon biochemical individuality, this drug can be either stimulating or sedating depending on the individual’s personal genetics, age and dosing level. It has been demonstrated that Remeron tends to be sedating at lower doses and stimulating at higher doses. This aspect alone can result in wildly different responses for the user. (8)

Antidepressants are generally thought to influence the relay of certain chemicals, hormones, neurotransmitters, in the central nervous system including the brain. In general, psychoactive drugs mimic, suppress, stimulate or cause these natural chemicals to accumulate, or cease to accumulate, leading to sometimes unpredictable results.

No drug creates natural hormones or transmitters; only a healthy, properly nourished body can produce the required substances to support and regulate the systems of the body.

Is Mirtazapine/Remeron an Antipsychotic?

No; mirtazapine/Remeron is an antidepressant, of the atypical tetracyclical class referring to the four atomic rings in its structure.

It is often used in conjunction with an antipsychotic medication. However, caution would be wisely employed here. In certain individuals Remeron can be stimulating. Additionally, there is theory regarding what is termed low-histamine psychosis as described most loquaciously by Carl C. Pfeiffer, Ph.D.,M.D. and Scott LaMola, B.S. in their published article entitled Zinc and Manganese in the Schizophrenias. (9)

Remeron’s potential of acting to block histamine 1 receptors may be worth discussing with your doctor when considering antipsychotics in combination with Remeron.

Is Mirtazapine/Remeron like Xanax (Benzodiazepine)?

There are some similarities between mirtazapine/Remeron and Xanax, a benzodiazepine drug. They are both used in the treatment of depression, anxiety and sleep issues.

They have different molecular/atomic structures and affect, influence, or alter the neurochemistry in different ways. Benzodiazepine drugs are thought to primarily affect GABA transmitters, and antidepressants are thought to be serotonergic, dopaminergic and influence other factors, such as norepinephrine.  The more common effects of Remeron typically surround sedation, which lends itself to being interpreted as having a benzo-like effect even though chemically it is highly different. Remeron is often used in combination with Xanax or other benzodiazepines. As stated previously, Remeron can also have a stimulating effect in a significant portion of the population treated with Remeron and this should be considered in persons considering its use, or who are experiencing unintended excitability or anxiety during its use.

Is Mirtazapine/Remeron a Controlled Substance?

Depending on the country, there may be different legal restrictions in place concerning Remeron/mirtazapine. Always check before traveling outside the US if you have concerns about traveling with a prescription drug of any kind.

In the USA, mirtazapine or Remeron is not considered by the FDA as a controlled substance. According to the FDA, the drug has not been adequately studied either in animals or humans to determine the potential for tolerance, physical dependence or abuse.  (10)

Treatment for Remeron (Mirtazapine) Abuse and Addiction?

At ATMC, we can help a person struggling with dependence to antidepressants such as Remeron/mirtazapine. Often, a medication can lead to side effects which become intolerable and this can lead to the decision to discontinue the medication.

In some cases, the person’s original symptoms were not helped by the medication, so while these are still present, there is the additional burden of withdrawal symptoms. This can be a debilitating situation, which could be better managed by inpatient care in a facility equipped to help alleviate both areas of distress.

Our protocols are time-tested over more than a decade. Each client’s program is individually designed and carefully monitored throughout the process to ensure the maximum safety and comfort of the client.

We agree with the DSA revising their diagnostic criteria, now requiring elimination of possible physical, pathological or environmentally linked or causative factors before turning to a prescription drug. This is a sound protocol, but, we have observed, it has not consistently been used in general medical or psychiatric practice.

Many people have been prescribed antidepressants whose depression, insomnia, or anxiety could have possibly been treated without drugs, had the investigative work been done prior to choosing prescription drugs as the first line treatment.

Nonetheless, our clinical experience informs us that a significant number, perhaps even a majority, may be suffering from an unnecessary over-prescription of medication that followed a substandard or completely absent investigation of root causes for their symptoms.

Oddly enough, many persons who had an addiction problem to street drugs are given Remeron by a drug treatment program, often times rather indiscriminately. We have seen many patients that struggle from reported dependence or addiction to Remeron following such treatment decisions.

We truly feel that reservation of a psychiatric diagnosis for drug addicts should be an operating guideline, at least until the person has had a period of time abstaining from their drug of choice and implementing healthy diet and behavioral modalities.

We invite you to contact us to see how we provide safe tapering, in our comfortable, relaxed and beautiful facility, under the supervision of medical staff and highly trained practitioners. Under an integrative approach, more comprehensive investigative steps are taken so we can show each client diversified points that need correcting either psychodynamically, nutritionally or that may respond to neurotoxic body burden removal, and other important clinically relevant and science-based tools. There is much more information we can provide to you on request.


This content has been reviewed, and approved by a licensed physician.

Dr. John Motl, M.D.

Dr Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor’s of Science degree with a major in biology and minors in chemistry and philosophy. He graduated Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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