Remeron Tapering

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

How Remeron tapering works

Tapering means lowering your Remeron (mirtazapine) dose step by step instead of stopping all at once. Stopping abruptly can cause withdrawal symptoms, and the FDA warns it can carry significant health risks.⁴

A safe taper is slow and gentle, ideally with medical oversight. Done this way, most people can finish without lingering withdrawal symptoms. Going too fast is what usually causes problems that drag on.³

The most common reason people come off Remeron is that its side effects start to outweigh the benefits. Some also learn their original diagnosis may not have been accurate. Researchers estimate 10–20% of medical diagnoses are incorrect.¹⁰

How ATMC tapers Remeron

Experts agree antidepressants need a slow, gradual taper.^3,4 How slow, and in what steps, is different for every person. That’s why we don’t use a one-size-fits-all schedule.

What your taper looks like at ATMC:

• Built around you. Your protocol is based on your dose, how long you’ve taken Remeron, other medications, and your history with withdrawal.
• Adjusted as you go. We watch how you respond and adjust the pace week by week. Some people move faster; others need to go slower. Both are fine.
• Precise doses. Cutting tablets at home gives uneven doses. We use precise methods, such as liquid preparations from a compounding pharmacy, so each step is the size it should be.
• Supporting your brain chemistry. Nutrient therapies and neurotransmitter support help your body rely less on the medication, so each step is easier to tolerate.
• Treating what’s underneath. Nutritional correction, toxin removal, and counseling address the factors behind the symptoms you were prescribed Remeron for.

Why going slowly matters: Remeron leaves the body over a day or more (its half-life is 20–40 hours), so withdrawal from a change often shows up a few days later.⁴ Moving too fast is what usually causes withdrawal that lingers.³

Remeron withdrawal symptoms

Withdrawal from antidepressants is common enough that it has a name: discontinuation syndrome.⁷ It’s most likely when Remeron is stopped too quickly or without support.

Symptoms can include:^8,9

• Headache
• Nausea and vomiting
• Dizziness
• Nightmares
• Insomnia
• Restlessness and anxiety
• Tingling or prickling skin (paresthesias)

When they start: usually 1–3 days after a dose cut.

How long they last: it varies. Some people have symptoms for a few weeks; for others they last longer. If withdrawal drags on (protracted withdrawal), it’s important to be under the care of a professional who knows how to taper Remeron.

Many of our clients were never told about discontinuation syndrome before starting Remeron.⁶ Most say that if they had known, they would have chosen a different treatment plan.

Tapering at home vs. at ATMC

How long does Remeron tapering take?

There’s no single timeline. It depends on your dose, how long you’ve taken Remeron, and how your body responds to each cut.

• Each step: paced to how you respond, not to a calendar.
• If you’ve tried before: people who stopped because withdrawal was too intense usually need more time, not less.
• Inpatient at ATMC: about 60 days on average, and longer stays can be arranged.

Giving yourself enough time is one of the most important parts of a comfortable taper.

Why people taper off Remeron

Remeron’s side effects differ from person to person. What’s mild for one person can be intolerable for another.

Common reasons people choose to taper:

• Side effects affecting daily life: dry mouth, mouth ulcers, swollen lips or tongue, drooling, bleeding gums, indigestion, and changes in taste or smell.
• More serious effects: vomiting, intestinal bleeding, worsening depression, sleep problems, agitation, shaking, flu-like symptoms, anger, twitching, restless legs, anxiety, and back or muscle pain.
• Severe reactions: suicidal thoughts, akathisia, mania, cycling mood states, confusion, pancreatitis, convulsions, and stupor. More information is available from the FDA.⁴
• Pregnancy: taking Remeron while pregnant has been linked to a higher chance of miscarriage and premature birth.²
• Weight gain: Remeron is linked to a significant increase in body fat and weight.¹³

Watch for severe reactions, physical or psychological. Some, like serotonin syndrome, hypothermia, or neurological symptoms, may need hospital care and sometimes stopping the drug immediately to protect the patient’s life.¹⁴

Remeron and PTSD

Remeron is sometimes prescribed for PTSD, but the criteria for diagnosing PTSD have changed several times.¹ A diagnosis can be hasty. For example, grief after a death, or symptoms caused by medications, illness, or substance use, should be ruled out first. When they aren’t, a person can end up with a diagnosis that isn’t accurate and a drug that may not help.

If you think Remeron was prescribed unnecessarily, talk with your prescriber or call us. It’s better not to wait: the longer you take a medication you didn’t need, the more complex coming off it can become. Learn more about antidepressant tapering.

How ATMC makes Remeron tapering easier

Alternative to Meds Center has specialized in antidepressant tapering for nearly 20 years, and our results are documented in published evidence. Many of our staff have been through withdrawal themselves.

Our inpatient program in Sedona combines five areas of care:

1. Neurotoxin testing and removal with gentle methods like nutrients, sauna, castor oil packs, nebulized glutathione, and mineral foot baths.
2. Diet and nutrition, including orthomolecular and environmental medicine, to support mood and energy.
3. Natural Remeron alternatives for sleep and mood.
4. Comfort and healing therapies such as massage, acupuncture, CBT, life coaching, equine-assisted therapy, mineral baths, Reiki, and gentle exercise.
5. Education on neurochemistry, diet and mood, the gut-brain connection, and avoiding toxic food additives.

A client’s story: this woman came to ATMC barely able to walk, taking benzodiazepines and antidepressants. She became medication-free and has worked as a professional counselor ever since.

Start your Remeron taper with support

Our Remeron tapering program lasts about 60 days on average, and longer stays can be arranged. Each client’s program looks for and addresses the factors that may have contributed to their symptoms in the first place, with the goal of natural mental health. Learn more about how we treat medication withdrawal, our residential program, and our Sedona facility.

Watch: Remeron withdrawal and mirtazapine tapering, explained.

More about Remeron

Remeron is a tetracyclic antidepressant: its chemical structure has four rings, unlike most other antidepressants. That’s one reason it’s called “atypical.” Exactly how it works in the brain isn’t fully understood.¹²

• It appears to act on histamine, adrenaline, dopamine, and serotonin receptors.
• At low doses it tends to be sedating; at higher doses, more stimulating.
• It’s associated with significant gains in body fat and weight.¹³
• Some studies show long-term antidepressant use may cause physical changes in the brain, and more research is needed.⁵

Mirtazapine tapering FAQs

Sources:

1. Matsumoto C. [Latest update on DSM-5]. Seishin Shinkeigaku Zasshi. 2014;116(1):54-60. Japanese. PMID: 24640552. [cited 2022 July 5].

2. “Djulus J, Koren G, Einarson TR, Wilton L, Shakir S, Diav-Citrin O, Kennedy D, Voyer Lavigne S, De Santis M, Einarson A. Exposure to mirtazapine during pregnancy: a prospective, comparative study of birth outcomes. J Clin Psychiatry. 2006 Aug;67(8):1280-4. doi: 10.4088/jcp.v67n0817. PMID: 16965209. [cited 2022 July 5].

3. Shelton RC. Steps Following Attainment of Remission: Discontinuation of Antidepressant Therapy. Prim Care Companion J Clin Psychiatry. 2001 Aug;3(4):168-174. doi: 10.4088/pcc.v03n0404. PMID: 15014601; PMCID: PMC181183. [cited 2022 July 5].

4. FDA Access Data Label Remeron (mirtazapine) [cited 2022 July 5].

5. Dusi N, Barlati S, Vita A, Brambilla P, “Brain Structural Effects of Antidepressant Treatment in Major Depression.” Current Neuropharmacology [Internet] 2015 [cited 2022 July 5].

6. Murray B, “Informed Consent: What Must a Physician Disclose to a Patient?” AMA Journal of Ethics 2012 [cited 2022 July 5].

7. Haddad PM. Antidepressant discontinuation syndromes. Drug Saf. 2001;24(3):183-97. doi: 10.2165/00002018-200124030-00003. PMID: 11347722. [cited 2022 July 5].

8. NAMI Fact Sheet: Remeron (mirtazepine) [online] [cited 2022 July 5].

9. Berigan TR. Mirtazapine-Associated Withdrawal Symptoms: A Case Report. Prim Care Companion J Clin Psychiatry. 2001;3(3):143. doi:10.4088/pcc.v03n0307a [cited 2022 July 5].

10. Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013;22 Suppl 2(Suppl 2):ii21-ii27. doi:10.1136/bmjqs-2012-001615 [cited 2022 July 5].

11. Wichniak A, Wierzbicka A, Walęcka M, Jernajczyk W. Effects of Antidepressants on Sleep. Curr Psychiatry Rep. 2017 Aug 9;19(9):63. doi: 10.1007/s11920-017-0816-4. PMID: 28791566; PMCID: PMC5548844. [cited 2022 July 5].

12. Anttila SA, Leinonen EV. A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001 Fall;7(3):249-64. doi: 10.1111/j.1527-3458.2001.tb00198.x. PMID: 11607047; PMCID: PMC6494141. [cited 2022 July 5].

13. Laimer M, Kramer-Reinstadler K, Rauchenzauner M, Lechner-Schoner T, Strauss R, Engl J, Deisenhammer EA, Hinterhuber H, Patsch JR, Ebenbichler CF. Effect of mirtazapine treatment on body composition and metabolism. J Clin Psychiatry. 2006 Mar;67(3):421-4. doi: 10.4088/jcp.v67n0313. PMID: 16649829. [cited 2022 July 5].

14. Choi T, Oh J, Cho J, Park J, Kim TH, Kang J, Hajek A, Kim J, Woo S, Hwang Y, Yon DK. Disproportionality analysis of serotonin syndrome associated with selective serotonin reuptake inhibitors: a pharmacovigilance analysis. Eur J Clin Pharmacol. 2025 Aug;81(8):1167-1175. doi: 10.1007/s00228-025-03856-0. Epub 2025 Jun 6. PMID: 40478261.[cited 2025 Dec 29].

15. van Os J, Groot PC. Outcomes of hyperbolic tapering of antidepressants. Ther Adv Psychopharmacol. 2023 May 9;13:20451253231171518. doi: 10.1177/20451253231171518. PMID: 37200818; PMCID: PMC10185864.  [cited 2025 Dec 29].

16. Cromarty P, Jonsson J, Moorhead S, Freeston MH. Cognitive behaviour therapy for withdrawal from antidepressant medication: a single case series. Behav Cogn Psychother. 2011 Jan;39(1):77-97. doi: 10.1017/S1352465810000512. Epub 2010 Sep 20. PMID: 20849682.  [cited 2025 Dec 29].

17. Maund E, Stuart B, Moore M, Dowrick C, Geraghty AWA, Dawson S, Kendrick T. Managing Antidepressant Discontinuation: A Systematic Review. Ann Fam Med. 2019 Jan;17(1):52-60. doi: 10.1370/afm.2336. PMID: 30670397; PMCID: PMC6342590.[cited 2025 Dec 29].

18. Heinrich KM, Patterson MS, Collinson B, Streetman AE. Exercise as Medicine for Addiction Recovery. Curr Sports Med Rep. 2025 Aug 1;24(8):235-239. doi: 10.1249/JSR.0000000000001271. PMID: 40758788.[cited 2025 Dec 29].

Originally Published Nov 2, 2019 by Lyle Murphy, Founder

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 of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from 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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Diane Ridaeus

Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.