Remeron has a
Highlights
- Mirtazapine (Remeron) is an antidepressant approved for major depressive disorder but often prescribed off-label for insomnia.
- Its effect comes mainly by blocking histamine receptors, which induces drowsiness and sleep.
- A low dosage (3.75 mg to 7.5 mg) often helps sleep better than a high dosage.
Not getting enough sleep each night can directly impact your mood, cognition, and productivity. To enhance your sleep, you can use several strategies. For example, setting up a sleep routine or taking sleep medication. If chosen correctly, medication can help you fall asleep faster and stay asleep longer. One medication prescribed off-label for insomnia is Remeron, commonly known as mirtazapine.
This article will explain how mirtazapine works, its possible side effects, and its commonly prescribed dosage for sleep.
What Is Mirtazapine (Remeron)?
Mirtazapine is a generic medication of the brand Remeron and it is a tetracyclic antidepressant in the NaSSA (noradrenergic and specific serotonergic antidepressant) class. It is FDA-approved to treat major depressive disorder (MDD). However, because of its sleep-promoting side effects, Remeron is often
How Mirtazapine Affects Sleep
How Does Mirtazapine Make You Sleepy?
Mirtazapine’s sedative effect comes primarily from blocking histamine H1 receptors. Histamine receptors can disrupt sleep when they are hyperactive, so blocking their activity leads to a sedating and calming effect. Mirtazapine also influences serotonin and norepinephrine pathways, which causes sedation and antidepressant effects.
Effects on Sleep Stages
Mirtazapine is known to
How Effective Is Mirtazapine for Insomnia
In people with MDD, mirtazapine
Evidence-Supported Benefits
Studies suggest that mirtazapine can positively affect sleep in the following ways:
- Improving sleep efficiency and quality (how well you sleep)
- Increasing total sleep time (how long you sleep)
- Decreasing sleep latency (how quickly you fall asleep)
- Increase the amount of time in slow-wave sleep (deep sleep)
Evidence-Supported Limitations
Since mirtazapine is not FDA-approved for sleep, research on its use for insomnia is limited. Most available studies are small and conducted in people with MDD, rather than those with primary insomnia. In addition, the research focuses on how mirtazapine affects sleep patterns rather than addressing the underlying causes of chronic insomnia. For long-term relief, it is important to work with a healthcare professional to identify and manage the underlying causes of your sleep problems.
Mirtazapine Dosage for Sleep
Remeron (mirtazapine) tablets come in doses of 15 mg, 30 mg, and 45 mg. It also comes in an oral disintegrating tablet form.
Mirtazapine is usually prescribed at lower doses for sleep disorders because it is more effective for sleep at lower doses than higher doses. Generally, a starting dose of 7.5 mg of mirtazapine is taken about 30 to 60 minutes before bedtime. A lower dose of 3.75 mg may be the best option for some people. The appropriate dose and use of any medication are determined by your healthcare provider based on your condition.
How Quickly Does Mirtazapine (Remeron) Make You Sleepy?
The effects will differ from person to person. Some people may notice an improvement in their sleep after the first dose, while others may notice a more gradual improvement. When taking mirtazapine for sleep problems, it may take 1-2 weeks for you to experience the benefits.
Does Mirtazapine Cause Next-Day Drowsiness?
One of the most common mirtazapine sleep side effects is somnolence. This is the medical term for sleepiness or drowsiness. This is often referred to as next-day grogginess or a hangover effect. This feeling can impact your daytime function. If this occurs, talk to your healthcare provider right away to determine the most appropriate action steps.
Side Effects and Risks of Remeron
Although Remeron is effective in treating depression and improving sleep, it is not without potential risks.
Common side effects include:
- Daytime drowsiness or grogginess
- Increased appetite and possible weight gain
- Dizziness
Strange dreams[6] - Nausea
- Dry mouth
- Constipation
Serious side effects aren’t common, but they can occur. They include:
- Suicidal Thoughts: Mirtazapine has a warning for suicidal thoughts and behaviors, especially in people who are 26 or younger. This risk is highest in the first few months of treatment or when the dose is changed. Ensure you are watching for any changes in mood, behavior, thoughts, or feelings. If you develop suicidal thoughts or actions, call your healthcare provider right away or the suicide hotline at 988.
- Serotonin Syndrome: Mirtazapine can increase serotonin in the body. If serotonin levels get too high, they can cause a life-threatening problem called serotonin syndrome. Some of the signs of serotonin syndrome are confusion, fast heartbeat, tremors, and seizures. If this happens to you, go to the nearest emergency room right away.
- Allergic Reactions: Allergic reactions are very dangerous if not addressed immediately. Signs of an allergic reaction include hives, swelling in the head, face, and neck, or trouble breathing. If you suspect an allergic reaction, call 911 immediately.
While mirtazapine can be effective for improving sleep, there are several long-term factors to consider:
- Metabolic Effects: Some people may experience weight gain with mirtazapine. In clinical trials, 12% of people taking mirtazapine for depression reported weight gain.
- Tolerance to Sedation: Over time, the sedative effects of mirtazapine may diminish, meaning it may become less effective for sleep.
- Rebound Insomnia: In some cases, stopping mirtazapine suddenly can cause rebound insomnia, where sleep problems temporarily worsen. This effect usually resolves within a few days.
- Withdrawal Symptoms: Sudden discontinuation of mirtazapine can also lead to withdrawal symptoms, such as anxiety, irritability, nausea, or flu-like sensations.
Alternatives to Mirtazapine
Non-Medication Options
Sometimes, individuals can overcome insomnia without medication, for example, through the following approaches:
- Sleep hygiene refers to healthy bedtime habits, like a specific bedtime, avoiding electronics before bed, and making your bedroom cool and relaxing.
- Cognitive-Behavioral Therapy for Insomnia (CBT-I) is a treatment for insomnia that helps you with initiating and maintaining sleep. The focus is to address the factors that cause insomnia.
Other Medications Sometimes Used for Sleep
There are multiple prescription and over-the-counter (OTC) medications used for sleep. Some common OTC sleep aids include diphenhydramine (Benadryl) and melatonin. Prescription options include:
- ramelteon (Rozerem),
- zolpidem (Ambien),
- benzodiazepines (e.g., diazepam (Valium), lorazepam (Ativan)),
- doxepin (Silenor),
- and certain antidepressants (e.g., trazodone, amitriptyline).
- Orexin receptor antagonists (lemborexant (Dayvigo), daridorexant (Quiviviq), and suvorexant (Belsomra))
Do not take any medication to treat insomnia without first consulting your healthcare provider. Together, you can determine the most appropriate medication for your individual needs.
When to See a Doctor
Mirtazapine may be an option to help sleep in certain people. It can be particularly helpful to those who have insomnia accompanied by depression or anxiety, or when other sleep strategies and medications have not been effective.
However, some people should avoid mirtazapine or use it only under close medical supervision. This includes individuals with bipolar disorder, severe liver disease, or those taking medications that could interact with mirtazapine. Examples of medications that interact with mirtazapine include triptans (used for migraines), certain antidepressants, some pain medications, and MAOIs (monoamine oxidase inhibitors).
Before starting any new medication, discuss all your current medications with your healthcare provider to prevent potential drug interactions. Also, it is important to follow up regularly with your healthcare provider while taking mirtazapine. Do not adjust your dose of medication on your own. Instead, be open and honest with your healthcare provider about how the medication is affecting you and work together to determine the safest and most effective plan for you.
In a Nutshell
If you’re having trouble sleeping and OTC remedies aren’t helping, talk to your healthcare provider to learn if sleeping pills like Remeron (mirtazapine) can be a suitable option. Remeron may be a safe alternative as a sleep aid, particularly for those with depression. A healthcare provider can advise you on the best course of action.
MEDvidi has clinicians authorized to offer online insomnia treatment in your state and prescribe medications online, according to local regulations. Book an appointment to see a healthcare provider in 24 hours, get your symptoms assessed, and determine whether mirtazapine is right for you.
Frequently Asked Questions About Remeron (Mirtazapine) for Sleep
Does mirtazapine (Remeron) help with sleep?
Yes, at lower doses, mirtazapine can help with sleep, especially for those with depression or anxiety.
Is 7.5 mg of mirtazapine enough for sleep?
Yes, the mirtazapine dosage for sleep is typically 3.75 mg to 7.5 mg before bed. These lower doses are often more sedating than higher doses.
Mirtazapine 15 mg vs. 30 mg — which is more sedating?
Lower doses are typically more sedating, while higher doses may reduce the sedative effect.
How long before bed should I take mirtazapine?
Take mirtazapine about 30-60 minutes before you are ready for bed. Ensure you are at home and not planning to drive or operate heavy machinery when you take it.
Can I take mirtazapine occasionally or as needed for sleep?
Mirtazapine is generally prescribed as a daily medication rather than on an as-needed basis. Its sedative effects may not be consistent if taken sporadically, and stopping and starting could affect your sleep or mood.
What’s the lowest and maximum dose of mirtazapine for sleep?
The lowest dose of mirtazapine for sleep is 3.75 mg. The mirtazapine max dose is 45 mg; however, this higher dose is usually used for depression, not sleep.
Can mirtazapine cause or worsen insomnia?
In rare cases, yes. Some people report mirtazapine causing insomnia, especially if they develop tolerance.
