Remeron (mirtazapine) is an atypical antidepressant used to treat anxiety, depression, and a range of other psychiatric disorders. It is also used to treat insomnia, nausea, headaches, stimulate appetite, and other uses.

This product is regular Remeron tablets, which should be swallowed whole. Patients who are unable or disinclined to swallow whole tablets may have better results with Remeron RD or Remeron SolTabs, both of which are designed to rapidly dissolve on the tongue without food or fluids. Dosage and administration is completely interchangeable among all three; if taking 45 mg of Remeron, 45 mg of Remeron RD or SolTabs provides the same benefit.

Getting the Most from Remeron

Remeron is used in a wide range of mental disorders as well as other, unrelated conditions. Treatment is similar in all cases, with the main variation being the maximum dosage. The medication is commonly used in:

• Major depressive disorder
• Generalized anxiety disorder
• Post-traumatic stress disorder
• Obsessive-compulsive disorder
• Social anxiety disorder
• Headaches, including migraines
• Nausea and vomiting
• Loss of appetite
• Panic disorder
• Insomnia
• Others

For the most part treatment will be similar regardless of the condition being treated; tablets are taken once per day, usually in the evening before bed. Food is optional. Dosage adjustments will be at least a week or two apart. In otherwise healthy patients:

• Start with 15 mg per day, ideally taken in the evening as the medication can cause drowsiness.
• Evaluate results after at least one, ideally two, weeks of treatment; it takes at least a week for full benefit to be felt, sometimes up to four weeks.
• If needed, increase dosage to 30 mg per day, and evaluate results after one to two weeks.
• Dosage may be again increased, if needed, to 45 mg per day.
• Do not exceed 45 mg per day without explicit doctor instruction.

Patients who have other major medical disorders, such as diabetes or kidney failure, may need adjusted doses.

In most cases treatment continues for six to nine months, occasionally much longer. It is fairly common for dosage to initially rise high, to 30 or 45 mg per day, until the condition is stabilized. Dosage may then be lowered to 30 or 15 mg per day for a longer-term maintenance dose.

Atypical versus Typical Antidepressants

Remeron is an atypical antidepressant; it ultimately produces the same effects as typical antidepressants (SSRIs, MAOIs, tricyclics, and so forth), but it does so in different ways. This means patients who are unable to take typical antidepressants---due to allergies, severe side effects, or they just don't work well---may have much better results with atypical antidepressants.

There are also some differences in side effects between atypical antidepressants and other classes, though there is a lot of overlap. In comparison, Remeron:

• Has a greater sedative effect than SSRIs, SNRIs, and MAOIs.
• Stimulates appetite more than most other antidepressants.
• Is less likely to cause muscle control issues than tricyclic antidepressants.
• Is less likely to cause sexual side effects than most antidepressants.

The first two side effects above---sedation and appetite stimulation---may be viewed as drawbacks by some. The medication is taken just once per day, so taking before bed is an option that largely resolves sedation. As an appetite stimulant, patients will need to watch what they eat, unless weight gain is desirable.

Precautions & Adverse Reactions

Remeron can produce side effects, though they're typically mild and often stop occurring after a few weeks of treatment. Side effects that become severe enough to be disruptive should be brought to the attention of a doctor. Most common are:

• Drowsiness
• Dry mouth
• Dizziness
• Constipation
• Weakness
• Muscle pain
• Headache
• Abnormal dreams

Remeron can interact with a wide range of other medications. Check with a doctor or pharmacist before starting, stopping, or adjusting dosage of other medications for the duration of treatment with Remeron. This medication should not be taken within two weeks of taking an MAOI.

There is an association with use of Remeron, as with any antidepressant, with an increased risk of suicide in younger patients under age 25. Young patients---particularly those under age 18---should be monitored closely for several months at the start of treatment and following any dosage adjustments. Suicide attempts were less likely in patients 25 and over.

All antidepressants and antipsychotics are associated with extrapyramidal symptoms (EPS), which describes movement disorders. While Remeron is less likely to produce these than other antidepressants, there is still a risk; patients should be alert for any signs the condition is developing:

• Muscle spasms
• Muscle rigidity
• Tremor
• Jerky, uncontrolled movement
• Slow or delayed movement

Any uncontrolled or unusual muscle movement should be brought to the attention of a doctor. In the vast majority of cases, ending treatment reverses symptoms.