Mirtazapine Withdrawal: Symptoms & Treatment

What is Mirtazapine Withdrawal?

Mirtazapine withdrawal, also called antidepressant discontinuation syndrome, may occur when individuals taking mirtazapine abruptly reduce or stop their use of the medication.¹ The abrupt discontinuation of the medication leads to an imbalance of brain chemicals, leading to withdrawal symptoms.

Mirtazapine (brand name Remeron) is an atypical antidepressant FDA-approved to treat major depressive disorder in adults. The timeline of mirtazapine withdrawal symptoms can vary widely among individuals and is dependent on several factors. Mirtazapine has a relatively longer half-life in comparison to other antidepressants.^{1, 2} The half-life of a medication refers to the time it takes for the body to eliminate half of the drug.

Due to the half-life of mirtazapine, the withdrawal symptoms may not be experienced until a few days after stopping the medication. These symptoms may worsen during the first week or two, and then gradually, the symptoms will decrease over the following weeks.³

Factors That Influence Mirtazapine Withdrawal

Several factors influence the symptoms of mirtazapine withdrawal, making it difficult to predict as it varies widely among individuals. Some individuals may experience little to no withdrawal symptoms, while others may experience a greater degree of severity of symptoms.

Factors that influence mirtazapine withdrawal include:

• Length of time taken: The longer an individual has taken the medication, the higher the risk for withdrawal symptoms.
• Dosage: Taking a higher dose of mirtazapine can increase the risk of withdrawal symptoms.
• Abrupt discontinuation: Suddenly stopping the medication can increase the risk of withdrawal symptoms. A gradual tapering off of the medication can lower this risk.
• Social support: Stopping mirtazapine can lead to a rebound of depression symptoms. Individuals who have good social support will be able to better cope with these symptoms.
• Metabolism: The removal of the drug by the body varies in individuals, and some individuals may be at a higher risk for withdrawal symptoms based on their unique metabolism.

Causes of Mirtazapine Withdrawal

Mirtazapine withdrawal can be caused by various factors, such as missing doses of the medication, abruptly stopping the medication, or switching to a different antidepressant. Missing a single dose of mirtazapine is unlikely to cause withdrawal symptoms, but the risk increases with the more doses that are missed. Abruptly stopping the medication places individuals at a higher risk for withdrawal symptoms. Switching from mirtazapine to another antidepressant can cause withdrawal symptoms, as each medication impacts the brain differently.

There are many reasons why someone may want to stop taking mirtazapine. Some individuals may not like how antidepressants make them feel. Others may need to stop the medication due to side effects. Some individuals may stop the medication as it may not be helping with their depression symptoms.

Mirtazapine Withdrawal Symptoms

Mirtazapine withdrawal symptoms can vary widely among individuals and can include physical and psychological manifestations. While many of the symptoms are mild and resolve over time, some of the withdrawal symptoms can be severe and require medical attention. The risk of withdrawal from mirtazapine is not well reported, but the risk likely depends on individual factors such as medical history, age, dosage, and duration of mirtazapine use.

Common Mirtazapine Withdrawal Symptoms

The common withdrawal symptoms of Mirtazapine are mild and do not require medical attention. These symptoms will typically occur during the first few days after stopping the medication. The symptoms may worsen during the first 1-2 weeks and then gradually resolve.

Some withdrawal symptoms, however, can last a month or more. Withdrawal symptoms can include physical symptoms or those felt by the body. Other withdrawal symptoms are psychological or noticed by an individual’s mood and thought patterns.

Common mirtazapine withdrawal symptoms may include:^{1, 3, 4, 5}

• Dizziness
• Restlessness
• Anxiety
• Headache
• Nausea
• Vomiting
• Insomnia
• Irritability
• Loss of appetite
• Weight loss

Serious Mirtazapine Withdrawal Symptoms

While many withdrawal symptoms are mild, some can be serious and require immediate medical attention. Though these symptoms are rare, it is important for individuals to be aware of them. The risk for severe symptoms depends on many factors, including the abruptness of stopping the medication, the higher the dose of the medication, and the longer the time the medication has been taken. Mirtazapine withdrawal has not been reported to cause death.

Treatment & Management of Mirtazapine Withdrawal

The treatment or management of withdrawal symptoms is dependent on the specific symptoms experienced. Often, treatment is focused on managing the symptoms until the withdrawal symptoms have subsided on their own.

Tapering Off Mirtazapine

Abruptly stopping mirtazapine increases the risk of developing withdrawal symptoms. Because of this, it is crucial to gradually taper the medication to lower the risk of antidepressant discontinuation syndrome. Tapering typically involves lowering the dosage over a specific period, allowing the body to adapt gradually to the lower dose.

Common tapering schedules involve reducing the dosage by 10-25% every 1-2 weeks until the medication is stopped. The tapering schedule can be adjusted as needed for each individual. It is essential to taper off mirtazapine under the guidance of a medical provider.

Supportive Therapies

Supportive therapies, such as counseling, cognitive-behavioral therapy, and support groups, can help lessen some of the withdrawal symptoms. These groups can be particularly helpful in reducing psychological withdrawal symptoms, such as anxiety, panic, depression, and mood swings.

Managing Physical Symptoms

The physical symptoms can vary from individual to individual, and many can be managed by prescription and over-the-counter medications. Some medications can help with nausea, headaches, and generalized achiness. It may be necessary to modify your lifestyle, such as taking time off work or not operating machinery, during the withdrawal period. It is important to talk with your healthcare provider about options available to manage physical withdrawal symptoms.

Managing Psychological Symptoms

Psychological symptoms, such as anxiety, depression, and panic attacks, can be harder to treat with medication. Although some medications can be used temporarily to help manage these symptoms. Other options that can help with psychological symptoms include therapy and support groups.

Discontinuation of Mirtazapine After Long-Term Treatment

Tapering off mirtazapine involves a gradual reduction in dosage to decrease the risk of withdrawal symptoms. Long-term use of mirtazapine can intensify the withdrawal symptoms in comparison to short-term use. The mirtazapine taper can often be performed over a month-long period.

For those taking mirtazapine after long-term treatment, an extended taper period may be needed. If withdrawal symptoms are too intense, you may need to begin retaking mirtazapine or switch antidepressants. There is also the possibility that individuals experience a relapse of depression symptoms when stopping the medication.

Discontinuation of Mirtazapine While Pregnant

While mirtazapine has not been shown to cause major birth defects, miscarriage, or negative outcomes for mom or baby, the risk of taking mirtazapine during pregnancy has not been well studied. Because of this, some individuals may not want to take antidepressants during pregnancy. For these individuals, it is important to discuss this with their medical provider to develop a plan when trying to get pregnant. It is also important to consider the risks of untreated depression during pregnancy.

Preparing for Mirtazapine Discontinuation

The first step in stopping mirtazapine is to set up an appointment with your healthcare provider. It is important to be aware of the possible withdrawal symptoms and risk for relapse of symptoms when stopping the medication. A healthcare provider can evaluate your unique situation and provide a tapering schedule. During this time, your healthcare provider may want you to follow up more frequently to assess your response to stopping mirtazapine.

How Long Does Mirtazapine Withdrawal Last?

The duration of mirtazapine withdrawal has not been well documented and can vary based on several factors, including individual response, tapering schedule, and medical history. In general, antidepressant discontinuation syndrome lasts 1-2 weeks. However, some symptoms can persist for up to 1 year, although this is rare.

Mirtazapine Withdrawal Timeline

The time it takes for withdrawal symptoms to appear and resolve can vary from individual to individual. The timeline for mirtazapine has not been well studied but is likely similar to other antidepressants.

Factors that may influence the withdrawal timeline of mirtazapine include:

• Dosage
• Length of use
• Tapering schedule
• Use of other medications

Here’s what you may expect for the withdrawal timeline for mirtazapine:^{1, 3}

• Days 1-3: The drug is just starting to be eliminated entirely from the body, and symptoms may begin to be apparent.
• Days 4-7: Withdrawal symptoms will likely be most apparent at this time due to the half-life of the drug.
• Days 8-14: Withdrawal symptoms will be apparent but may begin to lessen.
• Weeks 2-4: Resolution of withdrawal symptoms.

How Long Does it Take to Get Mirtazapine Out of Your System?

The half-life of mirtazapine, the time it takes for half the drug to be cleared from the body, is approximately 20-40 hours.^{1, 2} In general, a drug is considered to no longer have an effect after 4-5 half-lives. It can take approximately 80-200 hours for mirtazapine to be out of your system. This wide range is partly why individuals will experience withdrawal symptoms differently.

How Do I Safely Stop Taking Mirtazapine?

Safely discontinuing mirtazapine involves a carefully managed tapering-off process under the guidance of a healthcare professional, such as a primary care physician or psychiatrist. Abrupt discontinuation can lead to worse withdrawal symptoms. The tapering schedule is tailored to each individual to gradually reduce the dosage over several weeks to months.

Treatment for mirtazapine withdrawal is dependent on the specific symptoms experienced. Stopping mirtazapine and management of withdrawal symptoms should be done under the care of a healthcare professional. One option to consider is using online psychiatry services. These services are convenient for finding a medical professional to manage your psychiatric care.  Finding a therapist to work with may also help mitigate the mirtazapine withdrawal symptoms.

When to Seek Professional Help for Mirtazapine Withdrawal

Talk with your healthcare provider about the symptoms of mirtazapine withdrawal and when to seek immediate medical attention. Common withdrawal symptoms are mild and transient. However, some symptoms can be more severe. If you are struggling with intense withdrawal symptoms, reach out to your healthcare provider for guidance. Seek immediate help if serious symptoms occur, including suicidal thoughts, severe agitation, hallucinations, and severe mood changes.