Common questions about mirtazapine
Mirtazapine will not change your personality, it will simply help you feel like yourself again.
Mirtazapine-Associated Withdrawal Symptoms: A Case Report
Sir: Discontinuation symptoms associated with abrupt cessation of antidepressant medications including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs) are widely reported in the literature. 1 To date, there is only one published report of withdrawal symptoms associated with mirtazapine. 2 A case is presented herein of a patient who experienced withdrawal symptoms associated with the sudden discontinuation of mirtazapine.
Case report. Ms. A, a 25-year-old woman, was diagnosed with a major depressive episode, moderate and panic disorder without agoraphobia according to DSM-IV. She was taking mirtazapine, 60 mg/day, as well as clonazepam, 0.5 mg b.i.d. She was doing well until she had to go out of town unexpectedly due to a family emergency. Toward the end of her stay, she ran out of mirtazapine and within 48 hours began to notice anxiety, restlessness, irritability, nausea, vomiting, and insomnia. She continued taking clonazepam and did not experience any panic attacks. Upon her return, Ms. A was evaluated and restarted on mirtazapine therapy at her usual dose. Her symptoms completely resolved within 24 hours. At 3 months, she remains stable.
Sudden withdrawal from antidepressants can cause a variety of somatic and psychological symptoms. 3 Although the exact mechanism is not fully known, a state of serotonin dysregulation may play a role. 4 Schatzberg et al. 5 postulate that other neurotransmitters such as dopamine, norepinephrine, and γ-aminobutyric acid (GABA) may be involved, as well as cholinergic rebound. A state of dysregulation of both the serotonin and noradrenergic systems may have been involved in this particular case, given the pharmacologic profile of mirtazapine of enhancing both serotonergic and noradrenergic transmission. 6 Because sudden or abrupt cessation of antidepressant therapy can lead to a withdrawal or discontinuation syndrome, clinicians need to be aware of this possibility. Although the syndrome is time-limited, the symptoms can be troublesome to patients as well as contribute to decreased compliance, leading to unnecessary visits.
Conclusions and opinions expressed are those of the author and do not necessarily reflect the position or policy of the U.S. Government, Department of Defense, Department of the Army, or the U.S. Army Medical Command.
References
- Tollefson GD, Rosenbaum JF. Selective serotonin reuptake inhibitors. In: Schatzberg AF, Nemeroff CB, eds. The American Psychiatric Press Textbook of Psychopharmacology. 2nd ed. Washington, DC: American Psychiatric Press. 1998 219–237. [Google Scholar]
- Benazzi F. Mirtazapine withdrawal symptoms [letter] Can J Psychiatry. 1998;43:525. [PubMed] [Google Scholar]
- Lejoyeaux M, Adès J. Antidepressant discontinuation: a review of the literature. J Clin Psychiatry. 1997;58(suppl 7):11–16. [PubMed] [Google Scholar]
- Haddad P. The SSRI discontinuation syndrome. J Psychopharmacol. 1998;12:305–313. doi: 10.1177/026988119801200311. [DOI] [PubMed] [Google Scholar]
- Schatzberg AF, Haddad P, Kaplan EM, et al. Possible biological mechanisms of the serotonin reuptake inhibitor discontinuation syndrome. J Clin Psychiatry. 1997;58(suppl 7):23–27. [PubMed] [Google Scholar]
- Golden RN, Dawkins KD, Nicholas L, and et al. Trazodone, nefazodone, bupropion and mirtazapine. In: Schatzberg AF, Nemeroff CB, eds. The American Psychiatric Press Textbook of Psychopharmacology. 2nd ed. Washington, DC: American Psychiatric Press. 1998 251–269. [Google Scholar]
Articles from Primary Care Companion to The Journal of Clinical Psychiatry are provided here courtesy of Physicians Postgraduate Press, Inc.
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Common questions about mirtazapine
Mirtazapine is a type of antidepressant medicine.
It works by increasing the activity of mood-enhancing chemicals called noradrenaline and serotonin in your brain.
When will I feel better?
You may see an improvement in your symptoms after a week although it usually takes between 4 and 6 weeks before you feel the full benefits. That’s because it takes around a week for mirtazapine levels to build up in your body, and then a few weeks longer for your body to adapt and get used to it.
Do not stop taking mirtazapine just because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.
How will it make me feel?
Antidepressants like mirtazapine help to gradually lift your mood so you feel better.
You may notice that you sleep better and get on with people more easily because you’re less anxious. You’ll hopefully be more relaxed about things that used to worry you.
Mirtazapine will not change your personality, it will simply help you feel like yourself again.
Do not expect to feel better overnight, though. Some people feel worse during the first few weeks of treatment before they begin to feel better.
Are there any long-term side effects?
Mirtazapine is generally safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months or years.
What will happen if I stop taking it?
If you’ve been feeling better for 6 months or more, your doctor may suggest coming off mirtazapine.
Your doctor will probably recommend reducing your dose gradually over several months, or longer if you’ve been taking mirtazapine for a long time.
This is to help prevent you getting any withdrawal symptoms as you come off the medicine.
Side effects can include:
- feeling anxious, dizzy or sick
- numbness or tingling in your hands or feet
- headaches
- shaking
Important
Do not stop taking mirtazapine suddenly, or without talking to your doctor first.
How does mirtazapine compare with other antidepressants?
Mirtazapine is not any better or worse than other antidepressants. Sometimes people get on better with one antidepressant than another.
If you’re not feeling any better after 6 weeks, talk to your doctor. They may suggest that you try a different medicine.
Are there other treatments for depression?
Taking antidepressants, including mirtazapine, is just one of many ways to treat depression.
Other treatments that may help include:
- talking therapy such as cognitive behavioural therapy
- exercise programmes
- help to get a good night’s sleep
Choosing a treatment that’s most suitable for you depends on:
- how long you’ve had depression
- your symptoms
- whether you’ve had depression before
- whether previous treatment has worked
- how likely you are to stick with your treatment
- the potential side effects
- your preferences and priorities
Will it affect my contraception?
Mirtazapine will not affect any type of contraception, including the combined pill, progestogen-only pill or emergency contraception.
However, if mirtazapine makes you sick (vomit) or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.
- What to do if you’re sick or have diarrhoea when taking the combined pill
- What to do if you’re sick or have diarrhoea when taking the progestogen-only pill
Can I drive or ride a bike?
Some people cannot concentrate properly while they are taking mirtazapine. It can also make you feel sleepy.
When you first start taking mirtazapine, it’s a good idea to stop driving and cycling for the first few days until you know how this medicine makes you feel.
It’s an offence to drive a car if your ability to drive safely is affected. It’s your responsibility to decide if it’s safe to drive. If you’re in any doubt, do not drive.
Talk to your doctor or pharmacist if you’re unsure whether it’s safe for you to drive while taking mirtazapine. GOV.UK has more information on the law on drugs and driving.
Can I drink alcohol while taking mirtazapine?
You can drink alcohol while taking mirtazapine but it may make you feel sleepy and unsteady on your feet.
It might be best to stop drinking alcohol for the first few days of treatment until you see how the medicine affects you.
Drinking alcohol every day or in large amounts can make your symptoms worse. It also makes it harder for mirtazapine to work properly.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking mirtazapine.
Will I gain or lose weight?
Mirtazapine can make you feel more hungry than usual, so you may put on weight.
If you start to have problems with your weight while taking mirtazapine, talk to your doctor or pharmacist.
Will recreational drugs affect it?
Taking cannabis with mirtazapine can make you feel very sleepy, especially if you’ve just started taking mirtazapine.
It can be dangerous to take mirtazapine with:
- methadone
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (which used to be known as legal highs) like mephedrone
Find out about the side effects of some recreational drugs on the Frank website.
Important
Mirtazapine has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking mirtazapine.
More in Mirtazapine
Page last reviewed: 15 February 2022
Next review due: 15 February 2025
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