Remeron (mirtazapine)

US Brand Name: Remeron
A link here will take you to the official website for the drug.
Other Brand Names: Avanza (Australia)
Norset (France)
Remergil (Germany) Zispin SolTab (United Kingdom)
Generic Name: mirtazapine
Other Forms:
Class: Antidepressant
Read up on these sections if you haven’t done so already, because they cover a lot of information about multiple medications that I’m not going to repeat on many pages. I’m just autistic that way about not repeating myself.
FDA Approved Use: Depression
Off-Label Uses: Panic/Anxiety, Bipolar Depression, Sleep Disorders, Chronic Fatigue, Fibromyalgia, Arthritis, Lupus, Irritable Bowel Syndrome
Remeron’s pros and cons:
Pros: If serotonin and/or norepinephrine are the answer for you, Remeron will pull you out of the deepest, blackest depression like no other medication will.
Cons: You will literally eat sugar straight out of the bag to satisfy your cravings for sweets and carbohydrates.

Remeron’s Typical Side Effects: Most of the anticholinergic effects common with psychiatric medications are infrequent with Remeron. Instead you get intense hunger for the wrong foods, and with that comes weight gain, dry mouth and constipation. Then you want to sleep a lot. It’s like you may as well be smoking pot when you take Remeron.

For tips on how to cope with these side effects, please see our side effects page.

Remeron’s Not So Common Side Effects: Edema, dizziness, low blood pressure, increased thirst to go with the munchies, ‘flu-like symptoms.

These may or may not happen to you don’t, so don’t be surprised one way or the other.

Remeron’s Freaky Rare Side Effects: Going deaf and various flavors of herpes. Yeah, right, Remeron gave someone an STD. Remeron also carries a warning for agranulyocytosis, the severe reduction in white cell count, along with fever, infection and all that fun stuff. That hit Mouse like a ton of bricks. She was stuck in a motel in Fairfield for a week after one dose of Remeron.

You aren’t going to get these. I promise.

Interesting Stuff Your Doctor Probably Won’t Tell You: Remeron appears to be subject to a really quick poop-out, like after just a month or so. Works great, then quits on you.

Remeron will make you more drunk. So while liquor as no effect upon Remeron, the opposite is not true. Be careful if you mix booze and Remeron.

Remeron’s Dosage and How to Take Remeron: The initial dose of Remeron is 15mg. If no improvement is felt within two weeks, that may be increased to 30mg. If you’re still not feeling better a month after that, you can go up to 45mg and officially that’s it, although there are reports of some psychiatrists experimenting with doses up to 90mg. There are no other published dosage options for Remeron at this time, it’s just weird that way. 15, 30 or 45mg. Some of the more enlightened doctors are starting their patients at 7.5mg and titrating them in 7.5mg increments, and I’m all for that method. If I were you, and I got along with meds that messed with my serotonin, I’d insist on that. 7.5mg to start, up to 15mg after a week or two if no improvement, then 22.5mg after a month and so forth up to 45mg. I think the 90mg craziness is in response to Remeron poop-out, which is just exposing people to side effects for no good reason.

Days to Reach a Steady State: Five days.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.
How Long Remeron Takes to Work: Within two weeks.
Remeron’s Half-Life & Average Time to Clear Out of Your System: 20-40 hours. The average is 26 hours for guys and 37 hours for girls. Girls always take longer. So it’s out of a guy’s system in about days while it’s out of a girl’s in about seven days. to step down by 7.5-15mg a day, while a girl needs seven days to do that.

How to Stop Taking Remeron: Your doctor should be recommending that you reduce your dosage by 7.5 – 15mg a day every week if you need to stop taking it, if not more slowly than that. Based on the 20-40 hour half-life. For more information, please see the page on how to safely stop taking these crazy meds.
If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

How Remeron Works In Your Brain: Remeron enhances the activity around the receptors for serotonin and norepinephrine, so unlike the SSRIs and SNRIs, Remeron stimulates your brain to release more of the serotonin and norepinephrine it has. It also antagonizes the H1 histamine receptor (i.e. it’s one hell of a central nervous system antihistamine, sort of like super Benadryl), which is a big reason why you get so tired and so hungry. At 15mg it will also make you very sleepy, yet at 30 and 45mg the sleepiness sometimes isn’t so much of an issue. My guess is that at the higher dosages the extra norepinephrine regulates your sleep, trumping the sedation that often accompanies messing around with serotonin and histamine. Then again, sometimes not. Remeron has been studied for sleep disorders, not just making you sleep more but improving the quality of your sleep. It ranks up with trazodone as the official antidepressant of Sleepy-bye Land. Serotonin and norepinephrine are two of the big three neurotransmitters responsible for depression, along with dopamine. My wild-ass guess / rule of thumb is that imbalances of one or more of the three are responsible for 80% of the depression issues. It’s all just a matter of figuring out exactly the extent of the tweaking and what neurotransmitters you exactly need to tweak.

Comments: At any dosage it will make you crave doughnuts. Seriously. You will want to invest in Krispy Kreme stock (or maybe something along similar lines that isn’t tanking); as Remeron’s antagonism of the H1 receptor and stimulation of your serotonin production gives you the munchies for carbohydrates and sugars like you were 16 and smoking the best pot ever in the parking lot of a strip mall with a 24-hour doughnut shop beckoning you with glazed and jelly-filled ecstasy. People dipping spoons into a bag of sugar and eating it as is – not unheard of when on Remeron. This stuff is nothing more than legal marijuana, and if I knew crap about biochemistry I could probably prove that crazy statement. From a purely molecular-chemical perspective THC and mirtazapine are nothing alike. But there’s just something about how the two drugs work that is really close. And people who have self-medicated with pot respond really well to meds that really push the norepinephrine, and hard. Strattera, reboxetine, Cymbalta, and the more potent TCAs. And Remeron.
The production of extra serotonin and norepinephrine, and not just soaking neurons in what neurotransmitters are available, is sometimes the best solution to recalcitrant depression. When it works it makes people feel really good. I mean really good. Remeron is the closest thing to a happy pill on the market. Until you get all bummed out about how much weight you’ve put on and how little you do because you’re sleeping all the time.

Remeron is not for mild to moderate depression, it’s for people who are seriously depressed, who are willing to put up with the weight gain and the sleeping because those side effects suck much less than the dark pit of depressive despair one finds oneself in.

Just don’t mix Remeron with Zyprexa as your choice of antipsychotic and antidepressant. One woman was recently prescribed that combination as an inpatient in a Canadian hospital. She reported on the bipolar support forum on about.com how she ballooned up in weight, from 103 pounds to 162 pounds, in about six weeks, and carrying that on a 5’ 1″ frame. She gained a pound and a half a day, eating hospital food!

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