Remeron: Effective Relief for Major Depressive Disorder
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Synonyms
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Remeron (mirtazapine) is a prescription medication classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). It is primarily indicated for the treatment of major depressive disorder (MDD) in adults. By modulating key neurotransmitters in the brain, namely norepinephrine and serotonin, Remeron works to restore chemical balance, alleviating symptoms of depression such as low mood, loss of interest, and sleep disturbances. Its unique pharmacological profile offers a distinct alternative to SSRIs and SNRIs, often providing benefits where other antidepressants may have been ineffective or poorly tolerated. Clinical studies and real-world use support its efficacy in improving overall mood, energy, and quality of life for patients.
Features
- Active ingredient: Mirtazapine
- Available in 15 mg, 30 mg, and 45 mg orally disintegrating tablets (ODT) and standard tablets
- Noradrenergic and specific serotonergic antidepressant (NaSSA) mechanism
- Rapid onset of action, with some patients experiencing improved sleep within the first week
- Minimal impact on serotonin reuptake, reducing risk of certain side effects like sexual dysfunction
- Orally disintegrating formulation for ease of administration, especially in patients with swallowing difficulties
Benefits
- Effectively alleviates core symptoms of major depression, including persistent sadness and anhedonia
- Promotes restorative sleep by reducing nighttime awakenings and improving sleep architecture early in treatment
- May increase appetite and support healthy weight gain in patients experiencing weight loss due to depression
- Lower incidence of nausea and sexual side effects compared to many SSRIs
- Suitable for elderly patients due to a generally favorable side effect profile regarding cardiovascular parameters
- Can be used as a monotherapy or adjunctive treatment in treatment-resistant depression
Common use
Remeron is FDA-approved for the treatment of major depressive disorder (MDD). It is commonly prescribed for adults experiencing episodes of depression characterized by symptoms such as depressed mood, loss of interest or pleasure, significant weight change, sleep disturbances, fatigue, feelings of worthlessness, diminished ability to think or concentrate, and recurrent thoughts of death. Off-label, it is sometimes used for generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and as an adjunct for nausea/vomiting or sleep disturbances in palliative care settings. Its sedating properties make it particularly useful for depressed patients with comorbid insomnia.
Dosage and direction
The recommended starting dose for Remeron is 15 mg once daily, preferably taken in the evening prior to sleep due to its potential sedative effects. Dosage may be increased gradually, at intervals of 1–2 weeks, based on clinical response and tolerability. The effective dose range is generally between 15 mg and 45 mg daily. Doses above 45 mg per day are not recommended. Tablets should be swallowed whole with water; orally disintegrating tablets (Remeron SolTab) should be placed on the tongue and allowed to disintegrate, followed by swallowing with or without water. Dosage adjustments are necessary in patients with hepatic or renal impairment, and in the elderly.
Precautions
Patients should be monitored for clinical worsening, suicidality, or unusual changes in behavior, especially during the initial few months of therapy or after dose changes. Remeron may impair mental or physical abilities required for performing hazardous tasks, such as operating machinery or driving. Use with caution in patients with a history of seizures, hepatic impairment, renal impairment, cardiovascular disease, or bipolar disorder. Hypomania or mania may occur in susceptible individuals. Discontinuation symptoms (e.g., dizziness, nausea, sweating) may occur upon abrupt cessation; tapering is recommended. Pregnancy and breastfeeding require careful risk-benefit assessment under medical supervision.
Contraindications
Remeron is contraindicated in patients with known hypersensitivity to mirtazapine or any component of the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) is contraindicated due to the risk of serotonin syndrome; at least 14 days should elapse between discontinuing an MAOI and initiating Remeron, and vice versa. It should not be used in patients with severe hepatic impairment. Use is also contraindicated in individuals with a history of angle-closure glaucoma.
Possible side effect
Common side effects include somnolence (drowsiness), increased appetite, weight gain, dry mouth, constipation, and dizziness. Less frequently, patients may experience abnormal dreams, confusion, flu-like symptoms, peripheral edema, or elevated triglycerides. Although rare, serious side effects can include agranulocytosis (seek immediate medical attention for fever, sore throat, or other signs of infection), serotonin syndrome, hyponatremia, and activation of mania/hypomania. Most side effects are dose-dependent and may diminish over time.
Drug interaction
Remeron has the potential to interact with several medications. Concomitant use with MAOIs is contraindicated. It may enhance the sedative effects of alcohol, benzodiazepines, and other CNS depressants. Use with serotonergic drugs (e.g., SSRIs, SNRIs, triptans, tramadol) may increase the risk of serotonin syndrome. Caution is advised with drugs that prolong the QT interval. Mirtazapine is metabolized by CYP450 enzymes (mainly CYP1A2, CYP2D6, and CYP3A4), so inhibitors or inducers of these enzymes may affect its plasma levels. Dose adjustment may be necessary when used with strong CYP inhibitors.
Missed dose
If a dose is missed, it should be taken as soon as remembered, unless it is close to the time of the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended.
Overdose
Symptoms of overdose may include severe drowsiness, disorientation, impaired memory, tachycardia, and in severe cases, hypertension or hypotension. There is no specific antidote for mirtazapine overdose. Management is supportive and symptomatic, including monitoring of vital signs and ECG. Gastric lavage may be considered if presented early. Activated charcoal can be administered. Hospitalization and continuous monitoring are advised in cases of significant ingestion.
Storage
Store at room temperature (20°–25°C or 68°–77°F), away from light, moisture, and heat. Keep the medication in its original container, tightly closed, and out of reach of children and pets. Do not store in the bathroom. For Remeron SolTab (orally disintegrating tablets), keep the blister pack sealed until use to protect from moisture.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here. Never initiate, discontinue, or change the dose of a prescription medication without consulting your healthcare provider.
Reviews
Clinical trials and post-marketing surveillance indicate that Remeron is generally well-tolerated and effective for many patients with major depressive disorder. Patients often report significant improvements in sleep quality and appetite within the first weeks of treatment. Some note the benefit of minimal sexual side effects compared to other antidepressants. However, weight gain and somnolence are frequently mentioned as drawbacks. Individual experiences vary, and effectiveness depends on proper diagnosis, dosing, and patient-specific factors. Always discuss treatment outcomes and side effects with a prescribing healthcare professional.