Mirtazapine works differently from SSRIs and is often chosen when poor sleep and poor appetite are prominent, because it helps both. It has one genuinely counterintuitive feature: lower doses are usually more sedating than higher ones.
Once daily at bedtime, with or without food. Orodispersible tablets are placed on the tongue to dissolve and do not need water.
It commonly improves sleep within days, but the full antidepressant effect takes four to six weeks. Treatment is normally continued for at least six months after you feel well.
Lower doses (15mg) are usually more sedating than higher ones (30–45mg). If drowsiness is a problem, an increase may be the answer rather than a reduction — discuss it rather than assuming.
Drowsiness, increased appetite, weight gain, dry mouth, dizziness and vivid dreams are the common ones. Weight gain can be significant and is worth monitoring.
Do not drive until you know how it affects you. Alcohol adds considerably to the sedation.
Do not stop mirtazapine abruptly — withdrawal effects including nausea, dizziness, anxiety and agitation are common. Reduce gradually with your GP.
Tell your prescriber about other antidepressants, tramadol, triptans, St John’s wort, and any sedating medicines including sleeping tablets and opioids.
Discuss pregnancy and breastfeeding with your prescriber rather than stopping on your own.
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