- Remeron (Mirtazapine) Withdrawal Symptoms + How Long They Last
- Factors that influence Remeron withdrawal
- Remeron Withdrawal Symptoms: List of Possibilities
- Remeron Withdrawal Duration: How long does it last?
- Has anyone sucessfully withdrawn from mirtazapine ?
- Mirtazapine: A Newer Antidepressant
- Antidepressant use linked with weight gain
- What were the basic results?
- How did the researchers interpret the results?
- Links to the headlines
- Links to the science
Remeron (Mirtazapine) Withdrawal Symptoms + How Long They Last
Remeron (Mirtazapine) is a tetracyclic antidepressant (TeCA) drug that works primarily by raising levels of norepinephrine and serotonin in the brain. It is generally used to treat major depressive disorder, but is also sometimes prescribed as an anxiolytic (anti-anxiety), antiemetic, hypnotic, and appetite stimulant medication. Off label uses for Remeron include: social anxiety disorder, obsessive-compulsive disorder, PTSD, insomnia, and to increase appetite in those who are underweight or have eating disorders.
In regards to effectiveness as an antidepressant, a major meta-analysis study from 2009 found Remeron more effective than all SSRI’s, SNRI’s, and Bupropion (Wellbutrin). Despite the fact that its efficacy was considered superior to all other second-generation antidepressant medications, the degree to which it was superior was not statistically significant compared to Lexapro, Paxil, and Effexor. Other off-label uses for Remeron include: helping curb symptoms of drug withdrawal, treating the negative symptoms of schizophrenia, reducing Parkinson’s disease psychosis, and to treat anorexia in cats.
Although Remeron can work very well for pulling someone out of a deep depression, others find its side effects to be intolerable. Perhaps the most difficult side effect to cope with is the significant increase in appetite and cravings for carbohydrates (i.e. junk food). The major increase in appetite tends to result in significant antidepressant-induced weight gain among certain individuals.
Others who take this drug find it makes them feel too sleepy and/or it eventually “poops out” and stops working. If you have given this medication a shot, but no longer want to be on it, read below so that you have a general idea of what to expect during the withdrawal process.
Factors that influence Remeron withdrawal
When coming off of any antidepressant, there are going to be various factors that influence both the severity and duration of withdrawal symptoms. These factors include things like: the time span over which you took Remeron, your dosage, how quickly you tapered when discontinuing, as well as your individual physiology.
1. Time Span
Over how long did you take Remeron? In general, those who took it for an extended period of time may take longer to readjust to functioning without the drug. When you take an antidepressant every day for years, your body and brain become reliant on it for functioning. Those who took Remeron for shorter periods of time will likely have less severe withdrawal symptoms and shorter durations of withdrawal than long-term users.
2. Dosage (15 mg to 45 mg)
Most people start taking Remeron at a dose of 15 mg per day before going to sleep. Although there isn’t a relationship between dosage increase and effectiveness for treating major depression, some patients may benefit from increased dosages. A psychiatrist may have some people titrate up to a maximum dosage of 45 mg per day.
It is thought that individuals taking the minimum dose of 15 mg should have an easier time withdrawing than those taking higher doses (e.g. up to 45 mg). If you are on a higher dosage, you will likely need to conduct a gradual taper in order to minimize withdrawal symptoms.
3. Cold Turkey vs. Tapering
Quitting any antidepressant “cold turkey,” including Remeron is thought to yield more severe withdrawal symptoms than if you conduct a gradual taper. By tapering, you allow your body and brain to gradually adjust to changes in dosage. For long-term users, it is recommended to taper at a rate of 10% of your current dose per month. Therefore if you were at 45 mg, you would taper down to 40.5 mg to start, then after another month drop to 36.45.
When tapering you don’t have to necessarily be exact with your tapers, but if you round the dosage down, you may notice more severe withdrawal effects than you planned on. As you can see, a taper rate of 10% may take some individuals an extended period of time to successfully reach 0 mg. The whole idea is to taper slowly so that you don’t shock your nervous system by quitting cold turkey – which can result in severe discontinuation effects.
If you feel as though you can handle a quicker withdrawal rate than 10% per month, that’s your decision. Everyone will react differently to withdrawal and some people may not be as sensitive to the discontinuation effects as others.
4. Individual Physiology
Much of the withdrawal symptoms are based on individual circumstances. Since everyone is unique, each person tends to recover at a different rate and symptoms are subject to variation. One person may engage in mild exercise, eat healthy, get plenty of sleep, and stay hydrated which could facilitate a quicker recovery than someone who doesn’t exercise, get proper sleep, and dwells on their withdrawal symptoms.
During the withdrawal process it is important to avoid comparing your recovery to that of other people as each person usually recovers at a different rate. Additionally it should be noted that some individuals transition to a new antidepressant and/or are taking other drugs and may not experience as much of a withdrawal as a result of other medications.
Remeron Withdrawal Symptoms: List of Possibilities
Below are a list of symptoms that have been reported during discontinuation from Remeron. Keep in mind that you may not experience all of the symptoms listed below during your withdrawal. The withdrawal process is highly individualized in regards to what symptoms you will experience, their severity, as well as how long they last before you recover.
- Anxiety: Upon discontinuation, many people have reported major spikes in anxiety. The anxiety that you experience during withdrawal is likely linked to changes in the neurotransmission of serotonin and norepinephrine as a result of taking this drug. Many individuals report feeling anxious for an extended period of time after their last dose. Just know that the anxiety will eventually diminish as your brain reverts back to drug-free functioning.
- Appetite decrease: As was mentioned, this is a drug that can significantly boost your appetite. When you stop taking it, your appetite will likely return to what it was prior to taking this drug. It is this natural decrease in appetite that will lead you to lose most of the weight that you gained in relatively short order.
- Concentration problems: Many people report feeling spaced out and/or foggy thinking when initially quitting this medication. You may have trouble focusing on work-related tasks and/or schoolwork when coming off of this medication. As time passes, your concentration should come full circle and return to normal.
- Confusion: Some individuals become confused as to what they are experiencing during withdrawal. This confusion is generally a result of poor combination and cognitive function. The confusion and fog should eventually pass, but it may take some time.
- Crying spells: It is common to feel increasing depression when you withdraw from this medication. The increases in depression and other mood swings can lead to crying spells. During these spells many people feel completely hopeless about their situation. The reality is that they will eventually recover and these will subside.
- Depersonalization: This symptom involves feeling unlike your normal self, almost as if you have become a zombie and/or are panicking because you think you’ll never feel how you did prior to taking this drug. It can be very uncomfortable to feel depersonalized, but it’s generally a result of chemical changes that will change over time.
- Depression: Most people experience increases in depression when they withdraw from an antidepressant. In fact, the depression a person experiences in withdrawal is sometimes more severe than it was prior to their first dose of Remeron. This is due to the fact that when you withdraw from an antidepressant, a new chemical imbalance is created because your brain is now trying to function soberly after being fed a drug for weeks, months, or years. This new imbalance should correct itself, but it will require some time.
- Diarrhea: It is possible to experience diarrhea as a symptom when coming off of this drug. In order to minimize this particular symptom, a slow taper is recommended. Additionally consider taking some over-the-counter Imodium if it gets out of control.
- Dizziness: This is one of the most common symptoms that people experience during withdrawals. You may feel varying degrees of dizziness for weeks, or in some cases, months on end. The dizziness tends to be more extreme during the first few weeks of withdrawal. It can manifest as vertigo too in more extreme cases.
- Fatigue: It is common to feel lethargic and excessive tiredness when coming off of an antidepressant. The fatigue is usually due to the brain still not having fully rebounded back to normal after your last dose. The fatigue can last for quite some time, but your energy should return over time.
- Flu-like symptoms: Reports of flu-like symptoms and/or allergies upon discontinuation are fairly common. These symptoms tend to be intensified with “cold turkey” withdrawals and can be minimized if withdrawal is conducted gradually.
- Headaches: Having headaches is very common when a person first quits this medication. These headaches may last weeks, but affect some individuals for months after their last dose. Although these can be a nuisance, they usually subside once a person’s level of arousal and anxiety drops.
- Heart palpitations: Do you have sensations that your heart is pounding extra loudly or racing? These sensations are known as palpitations and are somewhat common during withdrawal. These can exacerbate anxiety and vice-versa so if you experience them, it is better to accept them as merely being a symptom rather than something to panic about.
- Hypomania: This is considered a lower-grade form of mania (i.e. mood elevation) exhibited by individuals with Type-2 Bipolar disorder. There have been cases of hypomania reported during withdrawals from Remeron.
- Insomnia: After quitting this drug, a lot of people struggle with falling asleep at night. A thing many people have found helpful is to take melatonin prior to bedtime. Additionally consider engaging in some sort of relaxation exercise such as deep breathing or meditation to mitigate insomnia.
- Irritability: When a person goes through withdrawal, they become highly sensitive and are prone to mood swings. A very common mood for a person to experience is that of irritability or the feeling that everything is a nuisance or bother. The person doesn’t want to feel this way, but due to their brain activity and neurotransmitter levels during withdrawal, it is an inevitable experience.
- Itching: One of the most common symptoms associated with Remeron withdrawal is that of itchiness. Many people report feeling very itchy and cannot contain the sensations to scratch their skin. This itchiness may be uncomfortable and persist for some time, but it will eventually go away as your nervous system adapts.
- Mania: During withdrawal from Remeron, individuals with bipolar disorder have been reported to experiencing a manic switch. In other words, if you have bipolar disorder, the withdrawal could make you transition to a state of mania. Although this will not occur in everyone with bipolar disorder, it is something to monitor during withdrawal.
- Mood swings: It is very common to experience changes in mood during withdrawal. Some days you may feel really depressed and angry, others you may feel hopeful and see the light at the end of the tunnel. Many people go through ups, downs, and changes in mood during the withdrawal process.
- Nausea: In some cases the nausea from withdrawal can become severe. If it becomes severe, the nausea can actually lead a person to vomit. To prevent severe nausea, make sure you follow a gradual tapering protocol. Some nausea upon discontinuation may be inevitable, but you will minimize it by slowly weaning.
- Panic attacks: During withdrawal from a potent drug that affects serotonin levels, it is possible to experience panic attacks. When you discontinue this medication, the levels of serotonin in your brain may be lower than average. This may lead you to feel increasingly anxious and make you prone to panic attacks. If you find yourself panicking, just know that these attacks will eventually go away as your neurotransmitters adjust.
- Racing thoughts: You may notice that your thoughts race when you initially come off of this medication. These racing thoughts are hypothesized to be what could potentially lead to mania or hypomania among susceptible individuals. In any regard, the racing thoughts can also be linked to anxiety, drops in serotonin, and heightened nervous system activity during withdrawal.
- Sleep changes: For many individuals, Remeron tends to improve their sleep. When coming off of the drug, you may notice that the quality of your sleep is reduced. You may have difficulty falling asleep, staying asleep, or getting an adequate amount of sleep each night. Your sleep patterns may fluctuate during withdrawal, but they will eventually stabilize.
- Suicidal thoughts: Many people who take this drug for depression may experience a resurgence of depression and suicidal thinking when they quit taking it. In some cases, the suicidal thoughts a person experiences during discontinuation could be significantly worse than prior to taking the drug. When withdrawing, your neurotransmission will often be imbalanced as a result of the drug you had been taking and discontinued. This imbalance is what can make people feel suicidal until their brain readjusts to normal functioning.
- Sweats: A very common withdrawal symptom from antidepressant medications is that of sweating. You may wake up during the middle of the night soaked in heavy night sweats and/or notice that you are sweating intensely throughout the day. This is one way your nervous system is readjusting itself and is part of the detoxification process.
- Tiredness: Although many people report heightened anxiety and difficulty sleeping when they withdraw from Remeron, others report feeling very tired. Additionally even individuals who have difficulty sleeping may notice lower than average energy levels throughout the day.
- Tremors: In various cases, people tend to notice that they are having “shakes” or tremors. This is a more common symptom in the acute stages of withdrawal. You will stop shaking once your body readjusts without the drug.
- Vomiting: Some individuals actually get pretty sick when they quit taking Remeron. If you quit cold turkey, your chances of vomiting increase because you have suddenly quit from a dose that your nervous system was used to getting. In order to decrease your chances of experiencing this symptom, take the time to gradually withdraw.
- Weight loss: Since most people tend to have increases in appetite and/or cravings for food when they are on this drug, they tend to gain weight. When the drug is stopped, most people have no difficulties losing the weight that they put on while taking the drug.
Remeron Withdrawal Duration: How long does it last?
Most people have reported withdrawal symptoms lasting a few weeks before the majority cleared up. However this doesn’t mean that everyone is going to feel back to their normal selves within one month of their last dose. How quickly you recover from withdrawal symptoms and adjust back to normal functioning will likely be influenced by individual circumstances including: your sensitivity to withdrawals, how quickly you tapered, and whether you are taking other drugs.
As a general rule of thumb that I recommend is to wait three full months (90 days) to reevaluate symptoms. Three months is a lengthy period of time and will give your body and brain some time to transition back to sober functioning. It may take some time before your nervous system and neurotransmitter levels revert back to how they were prior to your first dose of Remeron. Keep in mind that some people have reported experiencing symptoms over 6 months after their last pill – these are obviously the more extreme cases, but show how debilitating the withdrawals can be for some people.
After the acute symptoms have passed during the first couple weeks of withdrawal, take the time to make sure that you are engaging in healthy activities as this may help repair your nervous system. Getting some light exercise, eating healthy foods, staying productive, socializing, resting, and learning some relaxation techniques can go a long way towards speeding up recovery. What you are experiencing may be very uncomfortable and may push your mental limits, but maintain faith that you will eventually recover and you eventually will.
If you have successfully withdrawn from Remeron and/or are going through withdrawals, feel free to share your experience in the comments section below. Sharing your experience may really help another person who is dealing with the same thing.
Although this results in a lengthy detox period, it can help you cope with the withdrawals and allow time for your body to adjust to living without mirtazapine in your system. Mirtazapine typically stays in the body anywhere between four to nine days, depending on several different factors. When you take an antidepressant every day for years, your body and brain get plenty of sleep, and stay hydrated which could facilitate a quicker recovery than . Remeron Withdrawal Duration: How long does it last?.
It lasts about 10 hours. I feel somewhat detached from my body and noises seem far away. It isn’t an unpleasant feeling because during this, my anxiety is completely gone.
BUY REMERON ONLINE – CLICK HERE! Date: nick: moipecne how long does remeron stay in your system Best Answer: Half-life.
Mirtazapine (Remeron, Remeron SolTab) is an oral medication used to treat depression. As a result, higher amounts of a drug stay in your body for a longer time. What to do if you miss a dose: Take your dose as soon as you remember. How long does it take for 30 mg of Mirtazapine to take effect. Follow It took another couple weeks for my body to adjust and feel better. Mirtazapine received an overall rating of 7 out of 10 stars from reviews. For me the weight gain just isn’t worth it but it does work tremendously for . it the next day bc I had to ss to say this drug stayed in my system for 48 hours. I felt compelled to share just how much mirtazapine has helped me with long.
Mirtazapine – trusted advice on taking this antidepressant medicine, including mirtazapine for sleep How long does mirtazapine take to work?. Do not stop taking mirtazapine, even when you feel better. If you miss a dose of mirtazapine, take it as soon as you remember, unless it is closer to the time of. Remeron SolTabs should be allowed to dissolve in the mouth. Mirtazapine is broken down by the liver and eliminated from the body mostly by the kidneys.
Does mirtazapine help you sleep? Research has shown that Mirtazapine, taken at bedtime, to have a positive impact on insomnia symptoms in people with.
Please do not be worried by the side effects listed on this page. Many people take Discuss with your doctor how long you should take mirtazapine for. . Mirtazapine could raise the level of cocaine in your body, giving you a bigger reaction. However, in terms of long-term efficacy, mirtazapine was only equally as A patient’s chronic back pain did not respond to the drug amitriptyline but Mirtazapine possibly reduces the energy your body expands, which results in weight gain . .. It helps put me to sleep, and I seem to stay asleep better. I saw the doctor last week and she prescribed Mirtazapine and I took I was just wondering how long it took for the drug to come out of your system as I It sounds as if you do need to see your GP to discuss your medication.
I don’t do well without any sleep and therefore I would give up after a few days The withdrawal from mirtazipine depends on how long you have been taking it. syndrome where you need to be admitted to hospital because your body has. They do so by bringing chemicals in the brain back into balance. It helps relieve How Long Remeron Takes To Improve Depression. On average This allows the body and mind to slowly adjust to changes in the dose. If you’ve been Let them know to stay alert about rapid mood changes. If this occurs. 26 Feb – 12 min – Uploaded by brokenharbour Dropping from to really did not cause any withdrawal, however, Determined to stay.
Check for other emergency sources of Remeron before resigning to an How long does it take to be normal after quitting antidepressants after.
Do not start REMERON in a patient who is being treated with linezolid or intravenous . Events are further categorized by body system and listed in order of . There has been a long-standing concern, however, that antidepressants may have. This sheet talks about whether exposure to mirtazapine may increase the risk for birth defects over How long does the medication stay in my body?. You should also read the information leaflet supplied with the medication. Mirtazapine stays in the body a long time, so there is no point missing a tablet to.
How long do withdrawals from Remeron (Mirt) usually last. I was on 30 The drugs half life is hours, so I would guess about a week to get it out of your system. Not sure I stayed on for 3 months and hope to be rid of this drug soon.
So, I’ve thought about this and I am very dense when it comes to math. If I have not taken the remeron mg for two days, this being the third.
Find patient medical information for Mirtazapine Oral on WebMD including its uses, side effects and safety, What conditions does Mirtazapine Tablet treat?.
Advice & Tips: Should be taken at bedtime, helps you sleep. When I was depressed, it was very effective and my body adjusted to the sedation effects. due to difficulty sleeping, and it isn’t just difficulty getting to sleep but staying asleep too.
Well, they lessen over time, but some remain indefinately, speciffically having a Hi I took mirtazapine and it took around 2 weeks for my body to get used to it. .. so far i really do not have any of the side fx. i had a blood test last week to check.
Mirtazapine by Sanis: Mirtazapine belongs to the group of medications known such as body weight, other medical conditions, and other medications. If you are not sure what to do after missing a dose, contact your doctor or . sore throat or flu-like symptoms, contact your doctor as soon as possible. . Stay Connected . periods should periodically re-evaluate the long-term usefulness of the drug for . 7% of body weight was reported in % of patients treated with mirtazapine. The median length of stay for patients with single-agent mirtazapine . non- specific effects that do not meet the criteria for serotonin toxicity.
One of the known side effects of mirtazapine is weight gain. Do Mirtazapine is associated with weight gain both in the short- and long-term.
Mirtazapine should not be used in children and adolescents under the age of 18 In addition, long-term safety data in children and adolescents concerning.
How well does mirtazapine work in children and adolescents? You and your doctor can then discuss the best dosage to stay on This depends on the symptoms you have, how frequently they occur and how long you have had them. feet, muscle aches, fever and electrical sensations) as your body adjusts to being. Be careful if you drive or do anything that requires you to be alert. Others slow your body’s ability to burn calories or cause you to hold onto extra fluids. People who take Remeron want to eat doughnuts all day long. . and am seeing GP tomorrow as I am not prepared to stay on this drug any longer. Mirtazapine by Meliapharm: Mirtazapine belongs to the group of medications Do not stop taking this medication without consulting your doctor. such as body weight, other medical conditions, and other medications. Check with your doctor as soon as possible if any of the following side effects occur: . Stay Connected.
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Has anyone sucessfully withdrawn from mirtazapine ?
i foundthis website so helpful – everything this person describes is whats happening to me
i will copy & paste it below
The withdrawal from mirtazipine depends on how long you have been taking it. Someone who has been on it for 12 months or over is going to have much more severe withdrawal symptoms than someone who has been taking them for a few weeks or months. It also depends on what type of person you are. If you are able to bear intense suffering for a month- then a cold turkey method will suit you (but you run the risk of developing serotonin syndrome where you need to be admitted to hospital because your body has gone into shock and you could die). I have chosen a slow tapering method using a solution form of mirtazapine. I went from 30mg to 15mg to 15/7.5mg using the tablet form then from 7.5mg to 6mg using the solution and a syringe. I dont advocate dropping your dosage more than 2mg once you get past the 10mg dosage. The lower the dose gets the more sensitive you are to the drop. And all this rubbish about the drug having a short half life so all the withdrawal symptoms are really your own illness is RUBBISH. Thats what psychiatrists want you to believe because they dont understand the drugs they prescribe. If you drop your dose slowly it takes 2-3 weeks for the withdrawal symptoms to gain their full whack. My own withdrawal is at its worse at 3-4 weeks but this of course depends on the person. It has little to do with the half life because you are topping up your levels every night when you take your meds. I found that after 4 weeks everything just got better and better. Its called a slow withdrawal for a reason, the symptoms take longer to materialize and last longer but they are not as severe. If you can cope with the cold turkey without killing yourself i take my hat off to you! Another thing: why start taking a dangerous drug like valium to combat the withdrawal from mirtazipine? Its like out of the frying pan and into the fire. You then have to do the whole shibang again cutting up pills like a junkie. However, coming from a person who has withdrawed from mirtazipine AND valium, mirtazipine is indescribably worse. So think about that when you want to go necking more pills and prolong your pain. Some helpful tips for withdrawers- Ranitidine is great for nausea. Peppermint oil (called Colpermin in the UK) helps constipation or general digestive discomfort. Piriton or drowsy anti-histamines calms itchy skin and relieves insomnia. As for the anxiety and depression and paranoia, youre on your own but im guessing from reading most of these forums on the subjects we are all fairly used to those.
Hope that helps some worried soul out there who is sick of reading the same confusing and incorrect rubbish from people who dont know what they are on about.
If you do try cold turkey (like i did a bit ago) and you go seriously mental (like i did a bit ago) dont let the GPs whack you back up to 15mg. All you have to do is go back to the dose you were one before you went cold turkey and wait a week or two and then drop it down less dramatically. Remember: YOU know what your body can take and the doctors have no idea so do it your way. These rubbish antidepressants affect everyone differently so do it intuitively.
Mirtazapine: A Newer Antidepressant
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Braz J Med Biol Res, October 2001, Volume 34(10) 1303-1307 (Short Communication)
Mirtazapine versus fluoxetine in the treatment of panic disorder
L. Ribeiro, J.V. Busnello, M. Kauer-Sant’Anna, M. Madruga, J. Quevedo, E.A.D. Busnello and F. Kapczinski
Setor de Psicofarmacologia, Departamento de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
Correspondence and Footnotes
Mirtazapine is an antidepressant whose side effect profile differs from that of first-line agents (selective serotonin reuptake inhibitors) used in the treatment of panic disorder. The present study compared the effect of mirtazapine and fluoxetine in the treatment of panic disorder in a double-blind, randomized, flexible-dose trial conducted with outpatients. After a 1-week single-blind placebo run-in, 27 patients entered an 8-week double-blind phase in which they were randomly assigned to treatment with either mirtazapine or fluoxetine. Both groups improved significantly in all but one efficacy measure (P£0.01). ANOVA showed no significant differences between the two treatment groups in number of panic attacks, Hamilton Anxiety Scale or Sheehan Phobic Scale, whereas measures of patient global evaluation of phobic anxiety were significantly different between groups (F1,20 = 6.91, P = 0.016) favoring mirtazapine. For the 22 patients who completed the study, the mean daily dose of mirtazapine was 18.3 ± 1.3 vs 14.0 ± 1.0 mg for fluoxetine at the endpoint. Weight gain occurred more frequently in the mirtazapine group (50 vs 7.7%, P = 0.04) and nausea and paresthesia occurred more often in the fluoxetine group (P = 0.01). Results suggest that mirtazapine has properties that make it attractive for the treatment of panic disorder.
Key words: mirtazapine, fluoxetine, panic disorder, treatment, randomized trial
Many pharmacological agents have proved to be effective in the treatment of panic disorder such as the tricyclic and tetracyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and benzodiazepines (1). The side effect profile is an important issue when choosing a drug for the treatment of panic disorder, because these patients tend to amplify somatic sensations and are unusually sensitive to these effects (2).
Mirtazapine is an antidepressant with a unique pharmacological profile. One way to designate the pharmacological actions of mirtazapine is to consider it a noradrenergic and specific serotonergic antidepressant (3,4). The blockage of 5-HT2 and 5-HT3 receptors possibly prevents side effects associated with nonselective 5-HT activation and may also contribute to the anxiolytic and sleep-improving properties of mirtazapine (5,6).
The present study was a double-blind, randomized, flexible-dose trial comparing mirtazapine and fluoxetine in outpatients with panic disorder. After a thorough description of the study to potential subjects, written informed consent was obtained from each. The study was approved by the Ethics Committee of Hospital de Clínicas de Porto Alegre.
The first 30 outpatients who met entry criteria and were willing to participate in the protocol were enrolled. Assignment began on November 1998 and ended on March 1999. In order to be eligible, patients had to meet DSM-IV criteria for panic disorder, with or without agoraphobia, as assessed by a clinical interview. A qualified psychiatrist assessed all patients. The patients were submitted to a medical work-up which included an electrocardiogram, complete blood cell count, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl-transferase, blood urea nitrogen, creatinine, T4 and TSH. The participants were males and females 18 years of age or older, presenting a minimum of three panic attacks during the 2 weeks before enrollment. All patients scored at least 18 on the Hamilton Anxiety Scale and were free of major depressive disorder (i.e., £17 on the 17-item Hamilton Depression Rating Scale). Participants had not received previous treatment with mirtazapine and were not being currently treated with any psychoactive drug. Women of childbearing age who were not practicing birth control and pregnant or nursing women were excluded from the study, as also were patients presenting other psychiatric or physical disorders. Other reasons for exclusion were a history of seizures, organic brain syndrome, anorexia, bulimia, abuse of laxative drugs and substance abuse or dependence within the past 6 months. Participants were also excluded if they showed hypersensitivity to the study drugs or had used depot antipsychotics 2 months prior to the treatment period, fluoxetine 5 weeks prior to the treatment period, monoamine oxidase inhibitors, tricyclic antidepressants and other selective serotonin reuptake inhibitors 2 weeks prior to the treatment period. Patients were randomized to mirtazapine or fluoxetine using a computer program, which assigned 15 patients to each group. A person who was not participating in the study labeled flasks containing enough medication for periods between visits. The flasks were handed to the patients on the occasion of every appointment. Code breaking did not occur until the last participant finished the study. During the first week all volunteers were submitted to a single-blind placebo run-in (week 0). During the trial, patients received 15 mg mirtazapine or 10 mg fluoxetine daily with their evening meals for the first two weeks (weeks 1 and 2). After this, doses could be raised up to 30 mg mirtazapine or 20 mg fluoxetine according to the investigator’s judgment of clinical response and/or the absence of dose-limiting side effects. After this increase, the dose could be decreased at any time if significant adverse events were noticed. The use of benzodiazepines was not permitted during the trial. Organon Pharmaceuticals (São Paulo, SP, Brazil) kindly provided mirtazapine for the trial.
The patients were seen for evaluation at the end of weeks 0, 1, 2, 4, 6 and 8. Baseline assessment took place at the end of week 0. Two psychiatrists were responsible for applying the standardized interviews. Each patient maintained a self-reported diary of panic attacks (Panic Diary). Clinicians rated the Clinical Global Impression Severity Scale (CGI-S) and the Clinical Global Impression Improvement Scale (CGI-I). Patients were also assessed using the 14-item Hamilton Anxiety Rating Scale (7) and were assessed for phobic anxiety and phobic avoidance using the Sheehan Phobic Scale. The participants themselves provided patient global evaluation of phobic anxiety ratings. Adverse events were documented regardless of their assessed severity or relationship to study drug.
The analyses included all patients who took at least one dose of medication during the double-blind phase and who provided any follow-up data. Outcomes were analyzed by ANOVA for repeated measures. The factors analyzed were time, treatment and time-treatment interaction (General Linear Models, Repeated Measures routine of the SPSS, 8th version). Other continuous variables were compared by the Student t-test. For non-normally distributed data, the Mann-Whitney U-test was used. Categorical data were analyzed by the chi-square test or Fisher exact test when necessary. Statistical significance was set at the 5% level.
Thirty patients entered the run-in period. Three patients did not return after the first interview and were considered noncompliant, being excluded from further analysis. Hence, a total of 27 patients, 14 treated with mirtazapine and 13 treated with fluoxetine, were available for analysis. The groups did not differ in baseline demographic features or clinical characteristics. Mean age (years) was 36.1 ± 10.9 in the mirtazapine group and 36.4 ± 10.1 in the fluoxetine group and 86.7% of the participants in the mirtazapine group and 66.7% in the fluoxetine group were women. The median duration of illness was 36 months in both groups, with an interquartile range of 13-60 in the mirtazapine group and of 12-84 in the fluoxetine group. Agoraphobia was present in 66.7 and 80.0% of the patients in the mirtazapine and fluoxetine groups, respectively.
Twenty-two of the 27 patients completed the 8 weeks of the study. Three patients on fluoxetine and two on mirtazapine dropped out due to adverse events. Drowsiness, dyslalia, increased anxiety and tremor were the reasons for discontinuation in the mirtazapine group. Nausea, vomiting, epigastric pain, headaches and tremor were the reasons for discontinuation in the fluoxetine group. Some of the patients presented with more than one symptom. Discontinuation rates did not differ between groups. The types of adverse events according to medication group are shown in Table 1. At endpoint, the mean (± SD) daily dose of mirtazapine was 17.9 ± 4.3 versus 13.1 ± 3.2 mg for fluoxetine. For the 22 patients who completed the study, the mean daily dose of mirtazapine was 18.3 ± 1.3 versus 14.0 ± 1.0 mg for fluoxetine. The CGI-S Scale at endpoint was 1.9 ± 1.0 and 2.2 ± 0.9 mg for the mirtazapine and fluoxetine groups, respectively; this difference was not significant. The CGI-I Scale did not demonstrate a difference at endpoint. Both groups achieved a median of 1 point and interquartile ranges of 1-3 for mirtazapine and 1-2 for fluoxetine. Table 2 shows efficacy measures at baseline and endpoint.
Concerning the time factor, all but one efficacy measure showed difference from baseline to endpoint for a significance level of P£0.01, which means that both groups improved from baseline (Table 2).
Regarding treatment, the analysis showed no differences between treatments in all efficacy measures except one, i.e., patient global evaluation of phobic anxiety (P = 0.016) (Table 2).
The median number of panic attacks at endpoint was 0 in the two groups, demonstrating that both drugs came close to abolishing the attacks. The favorable outcomes in the study were obtained with relatively low doses of medication. The maximum fluoxetine dose was 20 mg daily but 20% of the patients in the fluoxetine group who completed the trial did not reach this dosage. In the mirtazapine group a greater percentage (50%) did not need the full dose of 30 mg. The fact that several patients did not need the full dose to become respondents may reflect a placebo effect. This cannot be confirmed or ruled out since a placebo group was not included. The side effects of mirtazapine observed in this study were similar to those reported in studies of mirtazapine for depression (8). In the present study, drowsiness and weight gain were the side effects with the highest incidence in the mirtazapine group. In conclusion, mirtazapine may be an alternative drug for the treatment of panic disorder, producing improvements similar to those obtained with fluoxetine in many clinically relevant dimensions of panic. To our knowledge this is the first randomized trial assessing the role of mirtazapine in the treatment of panic disorder. The present data support the hypothesis that mirtazapine is an antipanic agent with an effectiveness comparable to that of fluoxetine (9-11). However, the conclusions of this study should be interpreted carefully due to its small sample size. Further studies should be performed to establish a stronger basis to support the findings of our work.
3. Haddjeri N, Blier P & Montigny C (1995). Noradrenergic modulation of central serotonergic neurotransmission: acute and long-term actions of mirtazapine. International Clinical Psychopharmacology, 10 (Suppl 4): 11-17.
5. Boer T (1996). The pharmacologic profile of mirtazapine. Journal of Clinical Psychiatry, 57 (Suppl 4): 19-25.
8. Fawcett J & Barkin RL (1998). Review of the results from clinical studies on the efficacy, safety and tolerability of mirtazapine for the treatment of patients with major depression. Journal of Affective Disorders, 51: 267-285.
9. Michelson D, Pollack M, Lydiard RB, Tamura R, Tepner R & Tollefson G (1999). Continuing treatment of panic disorder after acute response: randomised, placebo-controlled trial with fluoxetine. The Fluoxetine Panic Disorder Study Group. British Journal of Psychiatry, 174: 213-218.
10. Michelson D, Lydiard RB, Pollack MH, Tamura RN, Hoog SL, Tepner R, Demitrack MA & Tollefson GD (1998). Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. American Journal of Psychiatry, 155: 1570-1577.
Correspondence and Footnotes
Address for correspondence: L. Ribeiro, Rua Otávio Dutra, 174/1003, 90810-230 Porto Alegre, RS, Brasil. E-mail: [email protected]
Research supported by FIPE-HCPA. Received December 5, 2000. Accepted July 18, 2001.
July 25, 2000 — Many patients with severe depression complain of trouble sleeping, but some of the medications used to treat depression may sometimes actually add to their sleep problems.
However, Remeron, a relatively new antidepressant, may prove to be particularly useful for these people, because it quickly alleviates depression and also helps them sleep better.
Many physicians have noticed that Remeron affects sleep, says Andrew Winokur, MD, PhD, lead author of a new study that explored Remeron’s effects on sleep. Depressed patients have reported that they sleep longer or heavier when they are taking it. On the down side, some of these patients have reported they feel sleepy during the daytime while on Remeron.
“Other have estimated that 80% of patients with depression experience problems with sleep … Our findings could give important practical information for who might want to know which drugs would have the best combination of both antidepressant effects and also help sleep,” says Winokur, of the University of Connecticut Health Center in Farmington.
In their report in the July 1 issue of the journal Biological Psychiatry, Winokur and his colleagues evaluated the effect of Remeron on patients’ sleep by studying their sleep in a sleep laboratory. Six patients who were diagnosed with severe depression and complained of sleep problems were selected.
The sleep-inducing effects of Remeron could be seen within the first week of treatment. Time taken to fall asleep decreased from about 15 minutes to five minutes. Total sleep time increased by about an hour a night — from six hours to seven hours. The amount of time the participants spent actually sleeping compared to the amount of time just spent in bed also increased, from about 83% to 93%.
“I think this study clearly showed is a medication that is useful in promoting sleep in patients with depression,” says Eric Nofzinger, MD, a psychiatrist affiliated with the Clinical Neuroscience Research Center at the University of Pittsburgh Medical Center in Pennsylvania. “That’s a very useful feature because a number of patients with depression have difficulties in initiating sleep and staying asleep.”
What were the basic results?
In the first year of the study 17,803 men and 35,307 women were prescribed antidepressants. The percentage of people prescribed antidepressants increased with each category of weight – from 13% in people with a normal BMI to 26.5% in those categorised as super obese.
Over the 10 year follow-up, people who were not prescribed antidepressants were less likely to have a 5% or more weight gain, with an incidence of 8.1 per 100 person-years compared to 11.2 per 100 person-years for those prescribed antidepressants. This gives an increased risk of 21% (adjusted rate ratio (aRR) 1.21, 95% confidence interval 1.19 to 1.22).
The risk of weight gain was highest in the first 1 or 2 years of being prescribed an antidepressant.
During the second year of antidepressant treatment, the chance of a 5% or more weight increase was 46.3%, when compared with people who were not taking antidepressants.
Mirtazapine was associated with the most weight gain.
How did the researchers interpret the results?
The researchers state that the increasingly widespread use of antidepressants is of concern in the context of the increasing prevalence of obesity. They go on to say that the potential for weight gain should be considered when antidepressant treatment is indicated.
Obesity is a global problem, and antidepressant use is increasingly widespread. This study shows a link between antidepressant use and weight gain. However, as it is a cohort study, it can’t prove a direct cause and effect.
Many people who gained 5% or more bodyweight in the study were already obese at the start of the study. This may suggest the weight gain is associated with peoples’ habits rather than the medication.
The study has a number of other limitations.
Although prescriptions are recorded in the GP databases, this does not necessarily mean the medication was taken. Therefore the number of people taking antidepressants may have been overestimated.
Older antidepressant drugs are more likely to cause weight gain than newer ones. As this study took place over 10 years, there was a switch in the use of old and new drugs during that time, which may have influenced the results.
The link between weight change and antidepressant use might depend on the dose of the drug, but it was not possible to access dosage information from the data.
Anyone concerned about the side effects of antidepressants should speak to their GP. You can also read more on the side effects of antidepressants.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
Rising antidepressant prescriptions could be contributing to increasing obesity levels, study finds
The Independent, 24 May 2018
Links to the science
Gafoor R, Booth HP, Gulliford MC.
Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study
BMJ. Published online May 23 2018