5 foods to be careful with if you take mirtazapine

In this article:

• How mirtazapine works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects
• Maximizing mirtazapine benefits

In this article

• How mirtazapine works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects
• Maximizing mirtazapine benefits

Roughly 11% of adults in the United States are on medication for depression, according to the U.S. Centers for Disease Control and Prevention. One of those drugs, mirtazapine, is FDA-approved to treat major depressive disorder, though it is sometimes used off-label for conditions that include insomnia, appetite stimulation, weight gain, bipolar disorder, and anxiety. 

If you’re taking mirtazapine (brand name Remeron), be advised that the drug does have interactions with a number of foods. Here, we’ll dive into the five you should consume with caution. 

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How mirtazapine works

Mirtazapine belongs to a class of drugs known as tetracyclic antidepressants that work by helping your brain keep more of certain “feel-good” chemicals—mainly serotonin and norepinephrine. It does this by blocking signals that normally slow down the release of these chemicals. As a result, more of them stay active in your brain, which can help improve your mood, energy, focus, and overall sense of well-being.

When it comes to how soon you’ll see results, the answer varies. You may see initial improvement in your energy, appetite, and sleep within just a week or two of starting mirtazapine. However, it could be up to six to eight weeks before there is significant progress with depressive moods.

5 foods and drinks to limit with mirtazapine

“Unlike other medications, mirtazapine does not interact with any specific foods,” explains Erika Gray, Pharm.D., founder and chief medical officer at ToolBox Genomics. “However, caution should be exercised around a few food groups.” Work with your healthcare provider to determine how much, if any, of the following are safe for you when taking this antidepressant.

1. Alcohol

It comes as no surprise that alcohol tops the list. Alcohol is a depressant that alters your brain chemistry, leading to inhibition, drowsiness, sedation, and lethargy. Drinking alcohol with mirtazapine puts you at an increased risk of sedation. 

Interestingly, in a study on people with both alcohol dependence and depression, those who took mirtazapine not only saw improvement with their mental health, but their average drinking dropped as well. In other words, you may want to drink less while taking the medication anyway.

2. Caffeinated drinks

While it isn’t dangerous to consume caffeine while on your medication, you may want to think twice about how much you have. Caffeine and mirtazapine are at odds with each other because caffeine is a stimulant, and mirtazapine has a sedative effect. While a comprehensive review found no significant interaction between the two, researchers noted that it may still feel like one is working against the other. 

“Drinking too much caffeine can cancel out the calming effects of mirtazapine and might make you feel jittery or agitated,” warns registered dietitian Ashley Kitchens, RDN, owner of Plant Centered Nutrition in Durham, North Carolina. 

3. Excessive amounts of grapefruit

Grapefruit, which is contraindicated with a number of medicines and supplements, affects the liver enzyme CYP3A4, which metabolizes mirtazapine. When this happens, it’s possible for the drug to pass into your bloodstream and potentially lead to dangerously high levels.

There is a lot of conflicting information about grapefruit and mirtazapine. However, the food may still be safe to consume if you stick to moderate amounts. “Grapefruit does inhibit the liver enzyme CYP3A4, but the other pathways are strong enough that you don’t need to totally avoid grapefruit,”  says Kitchens. “Eating one grapefruit is generally fine, but it’s probably not best to have several to avoid any interactions.”

4. High-calorie foods 

You don’t have to say goodbye to high-carbohydrate foods like cookies, cakes, and candy, but you should be mindful of how much you have. Weight gain is one of the most commonly reported side effects of mirtazapine because the drug blocks certain serotonin and histamine receptors that stimulate your appetite, along with cravings for sugar.

“Mirtazapine can result in an increased appetite, so beware of an escalation in cravings for carbohydrates and sweets, which could lead to rapid weight gain,” says Dr. Gray. Mirtazapine can also affect your cholesterol and triglyceride levels, which is all the more reason to avoid high-calorie foods.

5. Spicy foods

Who doesn’t love food with a kick? Unfortunately, your gut may not appreciate you downing habanero or kimchi if you’re taking mirtazapine. The medication can cause gastrointestinal distress, and spicy food may only make that worse. 

What should you eat while taking mirtazapine?

Your diet is one of the most important factors to consider when taking mirtazapine. There is no food that directly affects the drug’s absorption or effectiveness. However, because the medication can increase your appetite, experts recommend a balanced diet with lean meat, fruits, vegetables, and whole grains rather than one that favors high-calorie, low-nutrient foods. 

Mirtazapine may make you feel tired or sluggish. “Some people may find that the lower doses of 7.5 milligrams or 15 milligrams may make them feel sleepier than the higher doses,” says Dr. Gray. 

Eating certain foods, such as nuts, fruit, yogurt, and whole grains, may help mitigate exhaustion. Conversely, eating foods that make your blood sugar spike, like sweets, could cause even worse crashes if you’re on mirtazapine.

Gastrointestinal side effects of mirtazapine

Mirtazapine is generally well-tolerated. It is often prescribed to people who can’t tolerate the gastrointestinal (GI) issues that other medications cause. In fact, some studies have found that the drug can improve certain medical conditions, such as gastroparesis.  

However, some people may still experience adverse effects. One of the most common side effects is constipation. This happens because mirtazapine blocks 5-HT2 and histamine receptors, which can slow your gut motility. 

Less-frequently reported GI side effects of mirtazapine include dry mouth, diarrhea, nausea, cramping, and vomiting. While these are usually mild and resolve within days or just a few weeks, you should consult with your prescribing provider or seek emergency help if: 

• Constipation lasts more than a week
• You have ongoing abdominal pain that doesn’t improve
• You have blood in your stool or persistent vomiting
• Diarrhea lasts for several days

Some of the foods listed above, such as spicy foods and alcohol, can make these issues worse, which is another reason to avoid them or eat them sparingly. 

Non-GI side and potentially serious side effects of mirtazapine include glaucoma, sore throat, allergic reaction, low blood pressure, suicidal thoughts, low white blood cell count, and low sodium in the blood. If you experience any of these, be sure to contact your healthcare provider or seek emergency help. For thoughts of suicide, call or text 988 to connect with the 988 Suicide & Crisis Lifeline for immediate help.

Tips for maximizing mirtazapine benefits

To get the most out of this medication, Dr. Erika Gray recommends the following: 

• Take your medication in the evening: Mirtazapine is best taken at night since it has sedative effects. 
• Be consistent: Take your medication at the same time each day to avoid missed doses. If you miss a dose of mirtazapine, do not double up on your pills and just take the next dose as prescribed. 
• Use caution with food choices: Manage your diet to avoid weight gain, as this can lead some people to quit the medication.
• Stay hydrated: This can help reduce the risk of constipation.
• Swallow pills whole: Some people prefer to take medications by stirring them into applesauce or pudding to make them easier to swallow. However, crushing the pills may affect their effectiveness and absorption.
• Talk to your prescribing provider about supplement and drug interactions. Some people may use St. John’s wort, an herbal remedy, to treat depression. However, it can be incredibly dangerous and even life-threatening to combine St. John’s wort with antidepressants like mirtazapine. The same is true of selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). Doing so can cause excessive serotonin in your body, putting you at risk of serotonin syndrome. Share a complete list of all over-the-counter and prescription drugs you take to avoid a dangerous interaction.

Lastly, do not abruptly stop your medication. Doing so can cause a rapid change in your neurotransmitters, which can result in withdrawal symptoms including insomnia, anxiety, and irritability. If you want to make a change, consult with a healthcare professional for medical advice.