Remeron, known by its generic name mirtazapine, is an antidepressant. While approved by the FDA to treat major depressive disorder, it is also prescribed “off-label” for anxiety disorders like generalized anxiety disorder, panic disorder, and social anxiety. This is often considered when other medications have not been effective or when anxiety is accompanied by specific symptoms like insomnia or poor appetite.
How Remeron Works for Anxiety
Mirtazapine is a tetracyclic antidepressant (TeCA) that influences brain chemistry differently than selective serotonin reuptake inhibitors (SSRIs). Its primary function is to increase the levels of two neurotransmitters, norepinephrine and serotonin, which help regulate mood and emotion. By boosting the activity of these chemicals, mirtazapine can help alleviate the worry and unease associated with anxiety disorders.
The mechanism of mirtazapine is not fully understood, but it appears to work by blocking specific receptors on nerve cells. It acts on presynaptic alpha-2 adrenergic receptors, which boosts the release of both norepinephrine and serotonin. This is distinct from SSRIs, which prevent the reabsorption of serotonin, thereby making more of it available.
Mirtazapine also blocks certain types of serotonin receptors, specifically the 5-HT2 and 5-HT3 receptors. This action is thought to contribute to its anti-anxiety effects while causing fewer side effects like nausea or sexual dysfunction. It also has a strong blocking effect on histamine receptors, which results in sedation.
Common Side Effects and Management
Drowsiness or sedation is one of its most commonly reported side effects, caused by its potent blocking of histamine H1 receptors. The sedative effect is often more pronounced at lower doses of the medication. To manage this, doctors recommend taking the daily dose at bedtime, allowing the sedative effect to aid sleep rather than interfere with daytime activities.
Another frequent side effect is an increased appetite, which can lead to weight gain. This effect is linked to the medication’s impact on histamine and serotonin receptors. Managing this requires mindful eating and a healthy diet. Regular physical exercise can also help offset potential weight gain and may benefit mood.
Other side effects can include dry mouth, dizziness, and constipation. For dry mouth, staying hydrated and chewing sugar-free gum can provide relief. Dizziness can be managed by standing up slowly and avoiding sudden changes in posture. These side effects often diminish as the body adjusts to the medication.
Dosage and Timeline for Anxiety Relief
The dosage of mirtazapine for anxiety is initiated at a lower range, starting at 7.5 mg or 15 mg taken once daily. This dose is taken in the evening to utilize its sedative properties. A healthcare provider determines the appropriate starting dose and may gradually increase it if anxiety is not controlled, up to a maximum of 45 mg per day.
Initial effects, particularly sedation, can be felt quickly, sometimes after the first dose. However, the therapeutic benefits for anxiety take longer to become apparent. It requires consistent use for four to six weeks for the full anti-anxiety effects to be realized.
Individuals should follow their doctor’s prescribed dosage and not make adjustments on their own. The relationship between dose and response is complex, and an effective dose for one person may not be for another. Consistent communication with a healthcare provider is necessary to optimize treatment.
Important Safety Considerations
Mirtazapine should not be discontinued abruptly, as this can lead to a discontinuation syndrome with symptoms like dizziness, nausea, and agitation. A doctor will recommend a gradual tapering schedule, slowly reducing the dose over several weeks or months to allow the body to adjust and minimize withdrawal effects.
The FDA has issued a black box warning for mirtazapine, as with other antidepressants, regarding an increased risk of suicidal thoughts and behaviors. This risk is most noted in children, adolescents, and young adults, particularly at the beginning of treatment or after a dosage change. Patients and their families must monitor for any unusual changes in behavior or mood and report them to a healthcare provider immediately.
Caution is advised when combining mirtazapine with other substances that depress the central nervous system, such as alcohol, as this can increase drowsiness and impair coordination. The medication should not be taken with monoamine oxidase inhibitors (MAOIs) due to the risk of serotonin syndrome. Individuals with certain medical conditions, like liver or kidney problems or a history of seizures, may require dose adjustments or careful monitoring.