Mirtazapine for Anxiety: All You Need to Know

What Is Mirtazapine (Remeron)?

Mirtazapine, also known as Remeron, is a medication mainly used to treat major depressive disorder.¹ It’s like a mood-regulating helper for the brain. It’s approved by the FDA to help adults with depression feel better. It can also help with anxiety that often goes along with depression.

Mirtazapine is part of a group of drugs called alpha2-agonists that work by making certain brain chemicals, which control mood and feelings, work better. Remember, a doctor’s advice is needed for the right use of this medication as everyone responds differently to it, and the dose needs to be adjusted properly.

What is Anxiety?

Anxiety is a natural response that everyone experiences from time to time, but for some people, it can become overwhelming and interfere with daily life. Common anxiety symptoms include excessive worry, restlessness, a feeling of being on edge, difficulty concentrating, and physical symptoms like rapid heartbeat and sweating. These symptoms can occur on their own or accompany other mental health conditions.

Some specific types of anxiety disorders include generalized anxiety disorder (GAD) and panic disorder. In GAD, people often feel anxious about various aspects of life, even when there’s no immediate threat. Panic disorder, on the other hand, involves sudden and intense episodes of fear known as panic attacks, which can lead to a strong fear of having more attacks.²

How Does Mirtazapine Help Anxiety?

Mirtazapine is commonly used as an FDA-approved medication to treat major depressive disorder (MDD) in adults.¹ Mirtazapine, while not FDA-approved specifically for anxiety treatment, has shown potential as an option for medication for anxiety, especially when it co-occurs with depression.

The superiority of mirtazapine tablets over placebo was also found for certain factors of the depression symptoms, including:¹

• Physical (somatic) symptoms of anxiety
• Sleep disturbance

If you’re curious about using mirtazapine for anxiety, discuss this option with your doctor.

How Effective is Mirtazapine for Anxiety?

Research suggests that mirtazapine might be effective in reducing anxiety symptoms for patients with treatment-resistant depression (TRD). This means that mirtazapine might not only address depression but also provide relief from anxiety symptoms.³

However, it’s important to note that these findings are based on a specific study, and more research is needed to fully understand how well mirtazapine works for anxiety on its own. While these results are promising, it’s always best to consult a healthcare professional to determine the most suitable treatment approach for managing anxiety symptoms.

How Quickly Does Mirtazapine Work for Anxiety?

The effectiveness of mirtazapine for anxiety might become noticeable around 6 weeks into treatment, as suggested by a study. During this time, patients achieving certain improvement scores experienced a reduction in anxiety symptoms. Furthermore, those who continued mirtazapine treatment maintained lower relapse rates compared to those on placebo over the following 40 weeks, showing its potential to provide longer-term relief for anxiety.¹

Side Effects of Mirtazapine for Anxiety

Mirtazapine, like many medications, can lead to side effects as the body adjusts to its presence. Some of the most common side effects associated with mirtazapine tablets include sleepiness, increased appetite, weight gain, and dizziness. It’s important to understand that while these are frequent side effects, they might not occur in every individual.

Common side effects of mirtazapine for anxiety include:¹

• Sleepiness
• Changes in weight
• Nausea
• Increase in appetite

All medications, including mirtazapine, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Serious side effects of mirtazapine for anxiety that require immediate medical attention include:¹

• Hypersensitivity (severe allergic reaction)
• Suicidal thoughts and behaviors
• Agranulocytosis (severe drop in white blood cells)
• Serotonin syndrome (excessive serotonin levels)
• Angle-closure glaucoma (increased eye pressure)
• QT prolongation and Torsades de Pointes (abnormal heart rhythms)
• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) (severe allergic skin reaction)
• Activation of mania or hypomania (extreme mood shifts)
• Seizures (uncontrolled electrical activity in the brain)
• Hyponatremia (low levels of sodium in the blood)
• Transaminase elevations (abnormal liver enzyme levels)
• Discontinuation syndrome (withdrawal symptoms upon stopping the medication)

All medications, including mirtazapine, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Certain side effects mentioned above, like sleepiness and dizziness, might be more noticeable when treating anxiety disorders due to the heightened state of alertness that often accompanies anxiety. It’s crucial to pay close attention to any severe reactions, such as allergic responses or unusual heart rhythms. If symptoms become severe, seeking immediate medical help is important. While mirtazapine has shown effectiveness for treating some anxiety symptoms, careful monitoring and quick medical attention for any concerning side effects are vital for a safe and successful treatment experience.

When Should You Not Take Mirtazapine for Anxiety?

There are certain medications and situations where taking mirtazapine is prohibited. Particularly, avoid mirtazapine if you’re also taking antibiotics. If you’re allergic to mirtazapine or have a history of suicidal thoughts, depression, bipolar disorder, or mania, mirtazapine might not be suitable. If you’re unsure about taking mirtazapine, ask your healthcare provider first.

Mirtazapine may not be suitable for people who:¹

• Are pregnant or planning to become pregnant
• Have a history of certain health conditions, such as bipolar disorder or seizures
• Are taking MAOIs (medication typically used for nervous system disorders)
• Are taking linezolid or intravenous methylene blue (antibiotics)
• Are allergic to mirtazapine or its ingredients
• Have a history of suicidal thoughts or actions or depression
• Have glaucoma (high eye pressure)
• Have certain heart problems or a history of stroke
• Experience abnormal heart rhythms or have a family history of such issues
• Have low white blood cell counts
• Experience high cholesterol or triglyceride levels
• Have kidney or liver problems
• Have low sodium levels in the blood
• Experience low blood pressure

Drug Interactions With Mirtazapine

Disclaimer: Taking certain medications, herbs, or supplements alongside mirtazapine can change how mirtazapine works in your body or increase the risk of serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Medication interactions with mirtazapine can occur, potentially causing harmful effects. Always consult your healthcare provider to ensure the safe use of mirtazapine and other medications.

Medications that can have harmful interactions with mirtazapine include: ¹

• Monoamine oxidase inhibitors (MAOIs): These drugs affect certain brain chemicals. Combining them with mirtazapine can lead to serotonin syndrome, which is a dangerous condition causing confusion, rapid heartbeats, and more.
• Other drugs that affect serotonin: These are medications that also work on the same brain chemicals as mirtazapine. Mixing them with mirtazapine increases the risk of serotonin syndrome, which can be harmful.
• Strong CYP3A inducers: These drugs can change the levels of mirtazapine in the body. If taken together, they might make mirtazapine less effective.
• Strong CYP3A inhibitors: When combined with mirtazapine, they can increase its levels in the body, potentially leading to unwanted side effects.
• Cimetidine: Cimetidine is a medication commonly used to reduce stomach acid. When taken with mirtazapine, it can change how mirtazapine is broken down in the body. Combining them might cause mirtazapine levels to rise, possibly causing unexpected effects.
• Benzodiazepines and alcohol: Using these substances with mirtazapine can increase drowsiness and affect cognitive and motor skills. This can be risky, especially when driving or operating machinery.
• Drugs that prolong QTc interval: These medications can affect the heart’s electrical activity. When taken with mirtazapine, they increase the risk of abnormal heart rhythms, which can be dangerous.
• Warfarin: When taken alongside mirtazapine, warfarin (a blood-thinning medication) might lead to an increase in INR levels, affecting blood clotting.

Remember, these interactions can be harmful, so always talk to your doctor before combining any medications with mirtazapine.

Mirtazapine for Anxiety Dosage

When considering mirtazapine for anxiety, the dosage is determined by healthcare professionals based on various factors, including the individual’s overall health, response to treatment, and potential interactions with other medications. While mirtazapine’s primary FDA-approved use is for major depressive disorder, some research suggests it might suit certain anxiety conditions, particularly when it is intertwined with depression.

Prescribers carefully evaluate the patient’s specific situation to decide whether mirtazapine could be beneficial and at what dosage. It’s important to consult a healthcare provider to determine the most appropriate treatment plan, including the right dosage for managing anxiety symptoms.

How to Get a Prescription for Mirtazapine for Anxiety

To obtain a prescription for mirtazapine to treat anxiety, the first step is to consult a healthcare professional. Start by discussing your symptoms with your primary care doctor or a psychiatrist. They will evaluate your overall health, medical history, and the severity of your anxiety symptoms/

Additionally, online psychiatry services have become a convenient alternative. These platforms allow you to connect with licensed psychiatrists remotely and discuss your symptoms, medical history, and treatment options through virtual consultations.

Alternative Treatments for Anxiety

When facing anxiety, medication isn’t the only option. Cognitive behavioral therapy (CBT) for anxiety and exposure therapy are among the treatments for anxiety you may consider.

Additionally, online group therapy and support groups offer a sense of community. Lifestyle changes like exercise, a balanced diet, relaxation techniques, and enough sleep also help manage anxiety.

Alternative treatments for anxiety include:

• Cognitive behavioral therapy (CBT): CBT is a talk therapy where you work with a trained therapist to identify and change negative thought patterns that fuel anxiety. By learning new ways of thinking and coping, CBT for anxiety helps you gain control over anxious feelings and reactions.
• Exposure therapy: Exposure therapy helps you confront anxiety-triggering situations or objects in a safe and controlled way. Gradually facing these fears helps you become less sensitive to them, reducing anxiety over time. This technique is especially helpful for specific phobias and anxiety disorders.

It’s important to find what works best for you, and consulting professionals can guide you in choosing the right strategies.

Questions to Ask Your Healthcare Provider About Mirtazapine (Remeron) for Anxiety

If you’re considering mirtazapine (Remeron) for anxiety, there are several key questions to ask your doctor, psychiatrist, and therapist. You might want to inquire about how mirtazapine works, its potential benefits for anxiety, and possible side effects. Don’t hesitate to ask your psychiatrist about dosage adjustments, potential interactions, and any concerns you may have regarding its use in managing anxiety.

When discussing the potential side effects of mirtazapine with your care team, consider asking the following questions:

• Can I combine mirtazapine with therapy to manage my anxiety?
• How long might it take for my body to adjust to taking mirtazapine?
• Could my existing use of other antianxiety or antidepression medications increase the risk of severe symptoms?
• If I have a history of addiction, does that make me more vulnerable to dependency on mirtazapine?
• What dosage of mirtazapine is recommended to minimize side effects?
• Are there any medications I currently take that could negatively interact with mirtazapine?
• When should I contact you if I experience any side effects?
• Should I inform my therapist about starting this new medication?
• Are there specific lifestyle changes or precautions I should consider while taking mirtazapine?
• What are the common side effects of mirtazapine that I should be aware of?
• Can mirtazapine interact with any supplements or over-the-counter medications I might be using?
• How often will I need to follow up with you to monitor my progress and address any concerns?
• How can I reduce my risk of experiencing mirtazapine withdrawal?

Engaging in an open conversation with your doctor guides the treatment plan to align with your specific needs and circumstances. If you’re grappling with anxiety or related symptoms, my advice would be to reach out for help sooner rather than later. There is hope, and with the right guidance, you can navigate toward a brighter and more balanced future.

In My Experience

In my experience, the combination of medication, therapy, and lifestyle changes offers a well-rounded approach to addressing anxiety. However, it’s essential to remember that every individual’s journey is unique, and consulting with a healthcare professional remains paramount.

For Further Reading

• Stage Fright: Definition, Causes, & How to Get Over It
• Options for Anxiety Therapy