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Remeron Tapering

This entry was posted in Antidepressant on by .
Medically Reviewed Fact Checked

Last Updated on August 3, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Alternative to Meds Center offers safe and comfortable remeron tapering, titration, and weaning programs. For some, using antidepressants can quickly devolve into a nightmare of such suffering that it might lie outside of the ability of an outpatient setting to resolve.

The most common reason people seek to stop Remeron (generic mirtazapine) is that its side effects begin to outweigh any perceived benefits. If so, getting off Remeron may be the only logical choice where the drug has failed in expected treatment results.

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remeron titration
Alternative to Meds has been the authority on antidepressant tapering for nearly 20 years now. Our historical success is now documented in published evidence. Even if the person had what might be considered highly atypical medication reaction symptoms, these same symptoms are much more common than one might think. The reason we specialize in these symptoms is that many of us trained professionals at the center have also had to endure them ourselves in order to become effective guides on this journey to wellness.
This video is of a woman who came to ATMC years ago in a highly compromised state. She could barely walk, was on benzos and antidepressants, and could not even imagine working as the professional she once was. She became medication-free, gained the ability to power walk easily, and she has been consistently working as a professional counselor now in the years since she has graduated.
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About Remeron Tapering

It is not uncommon to be misdiagnosed in a brief outpatient visit. Some researchers estimate that between 10 & 20% of medical diagnoses were incorrect.10 Misdiagnosis is a common reason for considering tapering from Remeron. Of particular note, the DSM V (prescribers’ manual) may have upgraded its prescribing criteria since you began taking Remeron treatment.1

There can be many reasons for stopping Remeron; probably just about as many as there are side effects and individual situations. However, there is one point that is absolutely critical to understand for anyone contemplating Remeron tapering. And that is to avoid stopping Remeron abruptly. Weaning off Remeron safely requires a very gradual and gentle approach, preferably with compassionate, medical oversight and monitoring throughout the process. With these cautions in place, Remeron titration can be successfully completed without lingering symptoms of discontinuation. One will suffer from lingering reactions most profoundly where the process was done too quickly. The body needs to be allowed time to adjust and normalize. Otherwise, it may be nightmarishly difficult to endure.

Remeron Discontinuation Syndrome

effexor discontinuation syndromeProblematic antidepressant withdrawals are common enough that the phenomenon has been dubbed “discontinuation syndrome.” 7 The term refers to a cluster of symptoms a person may experience when Remeron is discontinued, especially when the withdrawal is done too quickly or without adequate preparation and support. According to NAMI, symptoms can include paresthesias (prickling or tingling sensations on the skin) headache, nausea, dizziness, vomiting, and nightmares. A single case report published in the Primary Care Companion to the Journal of Clinical Psychiatry also reported insomnia, restlessness, and anxiety as withdrawal symptoms.8,9

While physicians are ethically bound to inform their patients about the risks of treatment, exceptions exist.6 We have found, unfortunately, that most of our clients were not completely informed about Remeron discontinuation syndrome. This could be because the physicians themselves were uninformed. Often, no guidance was given as to how to stop taking antidepressant medication correctly. In fact, the majority say that had they known what was ahead for them, they would have decided on an alternative plan for treatment that didn’t involve antidepressants like Remeron. We can provide the level of care and support needed to safely resolve the challenges of Remeron tapering and discontinuation syndrome as comfortably as possible.

Remeron Tapering Guidelines and Schedule

remeron tapering guidelinesThe general consensus is that antidepressants require slow, gradual tapering to be tolerated.3,4 Tapering is only part of the process at Alternative to Meds. Our clients are provided the means to discover and resolve the underlying conditions that contributed to their original symptoms. If this does not occur, one could expect the original symptoms to reappear after cessation, and nobody would want that. The overall goal is to attain improved natural mental health, that is, without relying on drugs to be symptom-free.3

If you opt to taper outpatient-style, you will want to work out a plan with your prescribing physician to gradually cut the dosage which may involve actually cutting the pills. In the case of Remeron, the lowest dosage is the 15mg yellow oval tablets. The tablets can be cut in half when needed providing a 7.5mg option. Remeron has a half-life of 20-40 hours.4 The longer the half-life, the slower the medication will leave your body, which is a plus point for tapering.

Remeron Tapering Guidelines include:
  • Gradual cessation over time is recommended.3
  • Please be alert to severe adverse reactions (physical as well as psychological) that may require hospitalization and sometimes abrupt cessation to save the patient’s life, as in the case of too much serotonin, or serotonin syndrome.2
  • Work with the smallest pills available. In this case, it is 15mg Remeron yellow elliptical tablets
  • You can cut the 15mg pills in half for smaller dosing. You can even try to cut them into quarters with a proper pill cutter if truly necessary. A half pill would be 7.5mg and a quarter would be 3.75mg. A weight scale can be used if desired for better accuracy.
  • Try reducing by 10-25% and then adjust as needed up or down according to tolerance.
  • Half-life is a factor in determining when withdrawals will emerge. In this case, the elimination half-life is 20-40 hours depending on individual variability.4 Onset of Remeron withdrawal after making a cut may be felt on days 1, 2, or 3.
  • To let any changes settle out, wait 1 or 2 weeks or longer before making the next adjustment.
  • If the dose reductions close to the end of the taper become problematic, adjust to compensate for this phenomenon. Remeron is generally more stimulating at higher doses, and at lower doses assists with sleep. So if you are taking 30mg, the first cuts may not impact your sleep as much as the reductions at lower dosing.12

Each person is unique. Withdrawals may last only several weeks or could be prolonged longer. If protracted withdrawal develops, we cannot overstress the importance of being under the care of a professional who is familiar with tapering Remeron. As this is our specialty you are always welcome to call us to see whether inpatient help may be beneficial.

Remeron and PTSD

remeron and ptsdOne example of a potentially misplaced diagnosis revolves around PTSD, particularly common because the criteria for diagnosing a person with PTSD have changed a few times. A diagnosis of PTSD may have been hasty or premature. Some exclusions might be where a person has experienced death in the family, or when a close friend dies.1 Other examples can include symptoms caused by medications, illness, or substance abuse. These would be (should be) exclusions. But sometimes these exclusions are missed entirely, hanging a person with a diagnosis that is not accurate, and a drug that may not help. Remeron tapering may be indicated especially where the accuracy of a PTSD diagnosis was unclear or incorrect.

If you feel you may have been prescribed antidepressant medication unnecessarily, you may wish to speak about it further with your prescribing physician or call the Alternative to Meds Center. One can find out more about what steps are needed for antidepressant tapering. It is recommended that a person not delay in seeking this medical assistance. This is because the longer one remains on medication, especially where it was not the correct treatment to begin with, the more complex the process of getting off Remeron can become.

Side Effects as a Reason to Get Off Remeron

Like all antidepressants, Remeron side effects can be many, and they may be different for each individual in character, frequency, and also intensity.

Some side effects may be mild for one person, and intolerable for another. As seen below, there are mild, moderate, severe, and life-threatening reactions to Remeron.

Below are just some examples of what may lead a person to choose to taper off Remeron.

Reasons to Consider Tapering from Remeron:
  • Mild side effects have begun negatively affecting the person’s quality of life, such as dry mouth, ulcers in the mouth, swelling of the lips or tongue, drooling, bleeding gums, loss of ability to taste, indigestion, altered sensations of taste, smell, etc.
  • A person may experience more serious health concerns such as vomiting, bleeding intestines, worsened depression, sleep disturbances, and agitated. edgy or irritated feelings, shaking, flu-like symptoms (cough, fever, sore throat, headache), anger, twitching, restless legs, anxiety, back pain, muscle pain, etc.
  • Side effects have become extremely severe and in some cases may become life-threatening such as suicidality, akathisia, mania, manic-depressive cycling states, confusion, pancreatitis, convulsion, stupor, and other severe adverse reactions.*
  • A woman who becomes pregnant or plans to become pregnant may be concerned regarding the increased chance of miscarriage and premature birth that occur among mothers taking Remeron during pregnancy.2

*More information on severe side effects available from FDA.4

Remeron Tapering Made Simpler, Safer, Easier to Tolerate

Alternative to Meds Center provides an amazingly comprehensive treatment program that consists of too many segments to describe in this short article.

There are 5 main categories into which these therapies are organized at Alternative to Meds Center, as follows:
  1. Neurotoxin testing and removal by non-invasive and natural methods such as nutrients that biotransform toxins combined with sauna, castor oil packs, nebulized glutathione, mineral detox foot baths, and many other treatments.
  2. Dietary and nutritional corrections, orthomolecular and environmental medicine, etc., for enhancing neurochemistry replacement and improved energy, mood, etc.
  3. Natural Remeron alternatives that effectively replace prescription medicine, handle sleep issues, etc., without toxic drugs.
  4. Therapies for physical pain relief and healing as well as to provide mental and emotional comfort such as Reiki, therapeutic massage, life coaching, CBT, equine-assisted therapy, soothing mineral baths, acupuncture, and gentle trainer-led exercise classes, stress reduction techniques, and many, many more.
  5. There is also an educational component to the program where clients learn about neurochemistry, diet, and mood, how toxic food additives harm the CNS/brain, the gut-brain connection and how to protect it, and much more.
WARNING:  The FDA advises that abruptly stopping Remeron can result in significant risks to health.4

Additional Notes on Remeron

Remeron is an antidepressant drug in the tetracyclic class, meaning its atomic structure consists of 4 rings rather than the 3 rings or other variations in the chemical structure of other antidepressants. This is why, in part, Remeron is referred to as an “atypical” antidepressant, because it is believed that it has characteristics that are quite different from other types or classes of antidepressants. And, is important to note, that though theories exist, it is not known exactly how it creates the effects that it does in the brain and CNS.12

Some studies show that physical changes to the brain occur as a result of long-term use of antidepressants, and indicate that more research is needed.5 There are some indications suggesting Remeron affects the histamine receptors, adrenaline receptors plus dopamine, and serotonin receptors. But it is not exactly understood how these all interact exactly. At low doses, Remeron often has more of a sedative effect. At higher doses, the drug tends to have a stimulating effect. Mirtazapine is associated with a significant increase in fat mass and weight, as demonstrated in the study by Laimer et al published in the 2006 Journal of Psychiatry. It is clear, that the body of knowledge about antidepressants is far from complete.

How Long Does Remeron Tapering Take?

help getting off remeronThe Alternative to Meds Center Remeron tapering programs recommend that the client enrolls for 60 days, on average, although a longer stay can be arranged if requested. Our goal at the center is to provide the means for our clients to achieve natural mental health using holistic alternatives to prescription drugs. Clients are given a program that is designed to test for and address any possible factors that may have contributed to unwanted symptoms that were troubling the person before starting to take prescription medications. Remeron has a complex structure and side effect profile. Various potential interactions and reactions will be undergoing flux while a person attempts to normalize their neurochemistry during Remeron tapering. An adequate time frame in which to complete the Remeron cessation comfortably will be of great importance. The length of time for Remeron titration can vary, such as for a person who has already tried to quit but was balked by the intensity of withdrawals. The person will do much better with enough time allowed to safely complete their Remeron taper.

This approach is supported by nutritional testing and correction of deficiencies, neurotoxin testing and removal, and holistic therapies that address many other factors that may have never been previously addressed before being prescribed medication.

Please contact Alternative to Meds Center for a much more detailed description of our inpatient Remeron tapering programs and what benefits are available to all of our clients who wish to improve their mental health naturally.

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 ReportPrim 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 medicineBMJ 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].

Originally Published Nov 2, 2019 by Lyle Murphy, Founder

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

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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