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Remeron Withdrawal Symptoms

Remeron© withdrawal effects should be observed carefully, even when stopping Remeron slowly, as these include some potentially life-threatening events. Researchers such as Berigan 15 and Haddad 16 note the exact mechanism of withdrawals is unknown, though serotonin or other hormone dysregulation is suspected to play a role in the phenomena. The below list outlines some Remeron withdrawal symptoms that are listed on the drug’s FDA label.

Remeron withdrawal symptoms include:
  • Suicidal thinking or behaviors*
  • Thoughts of harming self, negative self-talk
  • Tremors, shaking
  • Disturbed sleep, nightmares, insomnia
  • Sensory disturbances
  • Nausea, vomiting
  • Decrease in appetite
  • Increased tiredness, fatigue, somnolence
  • Flu-like symptoms
  • Mood swings, crying spells
  • Agitation
  • Anxiety
  • Confusion
  • Depression
  • Irritability
  • Sweating
  • Headache
  • Prickling or tingling skin sensations 
  • Dizziness

*See the FDA black box warning for more information on the increased risk of suicide in specific age groups with Remeron (mirtazapine).


Physicians are some of the hardest working people on planet earth, but they are underserved in their medical training and left largely ill-equipped in how to do a proper Remeron withdrawal. As a result, the side effects and other complications are often allowed to continue far too long in their patients.

While Remeron© might have been prescribed to help with sleep, or lift depression, you may have found any relief at best temporary. You are not alone. Many patients have been left suffering and frequently, in a worsened state.

Do Your Symptoms Require Remeron?

successful remeron withdrawal
Alternative to Meds has been an antidepressant withdrawal help authority for over 17 years. Please review our independently verified published evidence regarding our clients’ success. There are other ways to find sleep and lift depression besides a lifetime of being medicated. Many of us have first-hand experience with the shortcomings of medications and consider ourselves not only professionals in this process but peers as well.
It is very common for us to hear “No one is like me.” And they are correct. Each person is biochemically and spiritually unique and needs to be treated as such. We are not a drug-based treatment model. We use environmental medicine and focus specifically on medication withdrawal and holistic treatment of symptoms. This video shows a woman who was broken, even in her spirit, and barely able to walk. She was imagining her life was over. She successfully completed a benzo and antidepressant withdrawal at ATMC and regained her ability to walk and also got her professional career back!
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Safe Remeron Withdrawal is Possible

Remeron withdrawal can be safely navigated with proper preparation, adequate education, and support along the way. The antidepressant Remeron (mirtazapine) is a tetracyclic atypical antidepressant medication used in the treatment of depression and other off-label uses in adults 18 and older.

As stated on the label, Remeron is not approved for patients under age 18 due to increased suicidal thoughts, as stated on the package’s Black Box warning.2 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. Remeron side effects are similar to many other antidepressant medications and may present as mild, moderate, severe, and potentially life-threatening. These reactions may lead to a decision to stop Remeron treatment and consider natural Remeron alternatives instead. Seek adequate guidance about how to safely get off Remeron and similar drugs before commencing the task.

Discontinuing/Quitting Remeron (mirtazapine)

Talk to a trusted healthcare practitioner who can help you devise and manage a structured, safe plan for Remeron withdrawal over an adequate period of time. Never attempt a “cold turkey” (abrupt) approach to coming off antidepressants of any type. Stopping Remeron can be done best with guidance and attentive medical support. Nutritional support is often overlooked but can be extremely helpful on the road to recovery.23

Inpatient treatment is advised, but if that is not available to you, talk to your prescriber about ways to help yourself during Remeron withdrawal such as minimizing work or other obligations for a period of time that may require a doctor’s letter. Even the WHO acknowledges that adequate rest is essential in any drug withdrawal management strategy.27

You are welcome to share the information here and on our antidepressant alternatives page and open a discussion with your physician.

Gradual Remeron Withdrawal Recommended

getting off remeronAbrupt Remeron withdrawal including the equivalent versions of mirtazapine causes withdrawal symptoms that can be overwhelming. But even slow withdrawal can cause adverse effects. The FDA and other regulatory bodies advise against stopping mirtazapine abruptly.

Please note:  A slow Remeron taper is recommended as this allows time for the body to adjust in a more gentle fashion.7

We will cover some frequently asked questions about Remeron and mirtazapine below. Please consult your primary caregiver for specific guidance or if you have concerns about taking mirtazapine or are considering Remeron withdrawal. Be aware of drug reactions that seem unusual or make you feel uncomfortable. To assist you in gathering information, we can also provide more information on request concerning stopping prescription medication safely. If the decision is made to stop taking mirtazapine, or any prescription drug, it should always be done with close medical oversight and competent guidance.

Testimonial
Remeron Withdrawal
Success

At ATMC I was always supported. The staff was great at providing opportunities for me to work towards stability. What helped me here was always keeping a positive outlook and constant encouragement and reminders to keep faith in myself.

~Jackie

 

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 certain diagnostic criteria.

  1. Symptoms should not be included that are clearly attributable to another medical or pathological condition.
  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) are supposed to be verified, but in practice, these criteria are too often ignored.1,6,7

IMPORTANT NOTE:

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. A plethora of alternative antidepressant therapies exist, that could prove safer and more sustainable without the negative side effects associated with drug-based therapy.

Such investigations would have to include, at a minimum, testing for nutritional deficiencies, environmental toxins in the current or past environment, food or other allergies, the body burden of neurotoxic elements like heavy metals, pathologies, drug use, developed dependence, and many other potential agents or influences or substances known to cause or contribute to a depressed state. A link between heavy metals exposure and psychiatric symptoms has been the subject of much eye-opening research, as seen in the clinical papers of Orisakwe 24 Attademo 25 Newbury 26 and so many others.

Heavy metals can be investigated with lab testing. Purging the system of these neurotoxins in a safe and gentle manner is a valuable step towards natural mental health. Vitamin and mineral deficiencies can also be tested for, providing valuable information used in rehabilitating neurotransmitter health for each individual client at Alternative to Meds Center. These are some examples of the types of protocols that are used in the Alternative to Meds Center Remeron withdrawal treatment and recovery programs.

Remeron (mirtazapine) off-label uses include:
  • PTSD, OCD, panic disorder, GAD, social anxiety disorder 17
  • Insomnia 3,17
  • Itching 18
  • Post-operative nausea 19,22
  • Tension headache, migraine headaches 17
  • As an appetite stimulant 4,5,17

Remeron (mirtazapine) Alternative Names & Slang

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

Remeron Side Effects

There can be a wide range of side effects — some of them paradoxical, that can be experienced while taking mirtazapine-type drugs. Suicidality, mania, hypomania, aggression, hostility, impulsivity, anxiety, panic attacks, agitation, worsened depression, and changes in behavior are particularly noted for emerging in the first month of treatment, or whenever the dosage is increased or decreased these symptoms can also emerge.2

Common Remeron Side Effects:

  • A Black Box warning on the Remeron insert lists several areas for caregivers to monitor closely — suicidality, changes in behavior, and clinical worsening, i.e., worsened depression.2,12
  • Other side effects can include anxiety, agitation, panic attacks, insomnia, irritability, hostility, somnolence, dizziness, vertigo, aggressiveness, impulsivity, akathisia (psychomotor restlessness), drowsiness, sedation, calming, sleep-inducing, increased cholesterol, constipation, xerostomia (dry mouth), appetite stimulant, weight gain, hypomania, and mania (presents as exaggerated self-esteem, decreased need for sleep, racing thoughts, impulsive behavior without regard for consequences, i.e., excessive shopping sprees, a flight of expansive or delusional thoughts, etc.)
  • Flu-like side effects are associated with virtually all antidepressants.14

More Rare Remeron Side Effects:

  • Infections, sore throat, cough, decreased white blood cell count, serotonin syndrome, renal impairment, tremor, hypertension, tachycardia, hyponatremia, akathisia, elevated transaminase enzymes 2,12,13,14

Remeron (Mirtazapine) FAQs

Remeron and mirtazapine have been around since the late 1990s. 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, and such 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 as similar to an SNRI even though the mechanism of action likely 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 on 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.7,8 Antidepressants are generally thought to influence the relay of certain chemicals, hormones, and neurotransmitters, in the central nervous system and 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 rehabilitate neurochemistry systems in the body. During Remeron withdrawal treatment, nutritional support can make a great deal of difference and can significantly ease the discomfort of the process.

Is Mirtazapine/Remeron an Antipsychotic?

No; mirtazapine/Remeron is an antidepressant, of the atypical tetracyclic class referring to the four atomic rings in its structure. It is often used in conjunction with antipsychotic medication. However, caution would be wisely employed here. There is the 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 H1 receptors may be worth discussing with your doctor when considering antipsychotics in combination with Remeron.

If one wishes to circumvent such complications altogether, it may be beneficial to consider mirtazapine alternative treatments before starting a prescription. Considering a natural substitute for mirtazapine might help avoid the need for a careful mirtazapine taper in the future.

Is Mirtazapine/Remeron like Xanax (benzodiazepine)?

There are some similarities between Remeron and Xanax. They are both used in the treatment of depression, anxiety, and sleep disorders. However, while Xanax is a benzodiazepine drug, Remeron is not. They have different molecular/atomic structures and affect, influence, or alter neurochemistry in different ways. Benzodiazepine drugs are thought to primarily affect GABA transmitters,21 and antidepressants are thought to be serotonergic, and dopaminergic, and influence other factors, such as norepinephrine and others. 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 Withdrawal and Recovery

At Alternative to Meds Center, we can help a person struggling with mirtazapine dependence or mirtazapine side effects. Often, mirtazapine side effects can become intolerable and this can lead to the decision to stop taking mirtazapine. In clinical trials, the number of participants who voluntarily opted for discontinuation was significantly higher than placebo, and other antidepressants comparatively.22

time-tested holistic mental healthWhile some participants felt the benefits outweighed the negative impacts, 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 Remeron withdrawal symptoms. Mirtazapine withdrawal can be difficult and could be better managed by inpatient care in a facility equipped to provide withdrawal help, as well as alleviate the original symptoms of distress.

Our protocols at Alternative to Meds Center are time-tested for nearly two decades now. Each client’s program is individually designed and carefully monitored throughout the mirtazapine withdrawal process to ensure the maximum safety and comfort of the client. If a client has not yet begun taking a medication, there are Remeron alternative treatments that could be considered.

Best Practices DSM Requires for Treatment

Alternative to Meds Center offers withdrawal help protocols that the most recent DSM revisions have begun to include in their diagnostic criteria. Best practices as delineated therein, now require the 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 that it has not been consistently or widely used in general medical or psychiatric practice. We are happy and relieved to see these protocols which have been in use at Alternative to Meds Center for nearly 20 years, now becoming more mainstream.

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, the wheels of progress sometimes turn slowly. 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 abused street drugs are given mirtazapine by a drug treatment program, oftentimes rather indiscriminately. We have seen many patients that struggle with reported mirtazapine dependence following such treatment decisions.

Alternative to Meds Center’s Approach

remeron withdrawal sedona arizonaWe truly feel that a psychiatric diagnosis for drug addicts should be put on hold as an operating guideline, at least until the person has had a period of clean time abstaining from their drug of choice and implementing a healthy diet and behavioral modalities, and other helpful remedies. Stopping mirtazapine or Remeron safely would be an important segment of that process and should be done gently and safely. Alternative to Meds Center has implemented a wealth of alternative treatments and natural methods for recovery after a drug injury. Some of these include investigative lab testing and diet correction, removal of neurotoxins from the body, relaxation and massage therapies, Equine therapy, Qi Gong, nebulized glutathione treatments, natural pain management, acupuncture, CBT, and other forms of counseling, and a host of others that can be viewed on our services overview page.

You are invited to contact us at Alternative to Meds Center to examine more closely how we provide a safe mirtazapine taper program, in our comfortable, relaxed, and beautiful inpatient facility, under the supervision of medical staff and highly trained practitioners. Using an integrative approach, comprehensive investigative steps are taken so we can show each client their exact profiled 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 Alternative to Meds Center can provide to you on request concerning Remeron withdrawal.

1 (800) 301-3753 for Remeron Withdrawal Help

1. Tolentino J, Schmidt S DSM 5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry 2018 Oct [cited 2022 July 27]

2. FDA drug label Remeron (mirtazapine tablets) approved 2007,2009 [cited 2022 July 27]

3. Karsten J, Hagenauw LA, Kamphuis J, Lancel M Low doses of mirtazapine or quetiapine for transient insomnia, a randomised, double-blind, cross-over, placebo-controlled trial. J. Psychopharmacol 2017 Mar [cited 2022 July 27]

4. Tajti J, Almas J Effects of mirtazapine in patients with chronic tension-type headache [Literature Review]. PubMed, Neuropsychopharmacol Hung [INTERNET] 2011 Jun [cited 2022 July 27]

5. Ringeisen H, Casanueva C, Stambaugh L, Bose J, Hedden S DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Center for Behavioral Health Statistics and Quality.(2016). 2014 National Survey on Drug Use and Health: (unpublished internal documentation). Substance Abuse and Mental Health ServicesAdministration, Rockville, MD. [INTERNET] [cited 2022 July 27]

6. Mirtazapine (Remeron) Information Sheet. NAMI [online] [cited 2022 July 27]

7. Leonard S, Karlamangla A Dose-dependent Sedating and Stimulating Effects of Mirtazapine. UCLA Healthcare [INTERNET] Vol. 19 2015 [cited 2022 July 27]

8. Abdulkader A, Voronovich Z, Carley J A Review of Therapeutic Uses of Mirtazapine in Psychiatric and Medical Conditions. PMCID 2013 Oct[cited 2022 July 27]

9. Pfeiffer C, LaMola S Zinc and Manganese in the Schizophrenias. Journal of Orthomolecular Medicine 1st quarter 1999 [cited 2022 July 27]

10. FDA Label Remeron/mirtazapine Revised 2016 [cited 2022 July 27]

11. Benazzi F. Mirtazapine withdrawal symptoms. Can J Psychiatry. 1998 Jun;43(5):525. PMID: 9653542. [cited 2022 July 27]

12. Jilani TN, Gibbons JR, Faizy RM, et al. Mirtazapine. [Updated 2021 Mar 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519059/ [cited 2022 July 27]

13. Watanabe N, Omori IM, Nakagawa A, Cipriani A, Barbui C, McGuire H, Churchill R, Furukawa TA; MANGA (Meta-Analysis of New Generation Antidepressants) Study Group. Safety reporting and adverse-event profile of mirtazapine described in randomized controlled trials in comparison with other classes of antidepressants in the acute-phase treatment of adults with depression: systematic review and meta-analysis. CNS Drugs. 2010 Jan;24(1):35-53. doi: 10.2165/11319480-000000000-00000. PMID: 20030418. [cited 2022 July 27]

14. Santarsieri D, Schwartz TL. Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs Context. 2015;4:212290. Published 2015 Oct 8. doi:10.7573/dic.212290 [cited 2022 July 27]

15. Berigan T, “Mirtazapine-Associated Withdrawal Symptoms – A Case Report.” Primary Care Companion to the Journal of Clinical Psychiatry 2001 [cited 2022 July 27]

16. Haddad P. The SSRI discontinuation syndrome. J Psychopharmacol. 1998;12(3):305-13. doi: 10.1177/026988119801200311. PMID: 10958258. [cited 2022 July 27]

17. Jilani TN, Gibbons JR, Faizy RM, et al. Mirtazapine. [Updated 2021 Mar 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519059/ [cited 2022 July 27]

18. Khanna R, Boozalis E, Belzberg M, Zampella JG, Kwatra SG. Mirtazapine for the Treatment of Chronic Pruritus. Medicines (Basel). 2019 Jul 6;6(3):73. doi: 10.3390/medicines6030073. PMID: 31284577; PMCID: PMC6789675. [cited 2022 July 27]

19. Feighner JP. Mechanism of action of antidepressant medications. J Clin Psychiatry. 1999;60 Suppl 4:4-11; discussion 12-3. PMID: 10086478. [cited 2022 July 27]

20. Sato H, Ito C, Tashiro M, Hiraoka K, Shibuya K, Funaki Y, Iwata R, Matsuoka H, Yanai K. Histamine H₁ receptor occupancy by the new-generation antidepressants fluvoxamine and mirtazapine: a positron emission tomography study in healthy volunteers. Psychopharmacology (Berl). 2013 Nov;230(2):227-34. doi: 10.1007/s00213-013-3146-1. Epub 2013 Jun 1. PMID: 23728612. [cited 2022 July 27]

21. Haefely W. Benzodiazepine interactions with GABA receptors. Neurosci Lett. 1984 Jun 29;47(3):201-6. doi: 10.1016/0304-3940(84)90514-7. PMID: 6147796. [cited 2022 July 27]

22. Alam A, Voronovich Z, Carley JA. A review of therapeutic uses of mirtazapine in psychiatric and medical conditions. Prim Care Companion CNS Disord. 2013;15(5):PCC.13r01525. doi:10.4088/PCC.13r01525 [cited 2022 July 27]

23. Grosso G. Nutritional Psychiatry: How Diet Affects Brain through Gut Microbiota. Nutrients. 2021 Apr 14;13(4):1282. doi: 10.3390/nu13041282. PMID: 33919680; PMCID: PMC8070365. [cited 2022 July 27]

24. Orisakwe OE. The role of lead and cadmium in psychiatry. N Am J Med Sci. 2014 Aug;6(8):370-6. doi: 10.4103/1947-2714.139283. PMID: 25210669; PMCID: PMC4158644.[cited 2022 July 27]

25. Attademo L, Bernardini F, Garinella R, Compton MT. Environmental pollution and risk of psychotic disorders: A review of the science to date. Schizophr Res. 2017 Mar;181:55-59. doi: 10.1016/j.schres.2016.10.003. Epub 2016 Oct 6. PMID: 27720315. [cited 2022 July 27]

26. Newbury JB, Stewart R, Fisher HL, Beevers S, Dajnak D, Broadbent M, Pritchard M, Shiode N, Heslin M, Hammoud R, Hotopf M, Hatch SL, Mudway IS, Bakolis I. Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders: retrospective cohort study. Br J Psychiatry. 2021 Dec;219(6):678-685. doi: 10.1192/bjp.2021.119. PMID: 35048872; PMCID: PMC8636613. [cited 2022 July 27]

27. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310652/ [cited 2022 July 27]

Originally Published Sep 13, 2018 by Diane Ridaeus


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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Remeron Withdrawal Symptoms, Mirtazapine Side Effects, Treatment Help
Medical Disclaimer:
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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