Mirtazapine for sleep: Can mirtazapine help with sleep?

Mirtazapine is a prescription medication that is FDA approved to treat major depression. It is commonly known by its brand name Remeron. As a tetracyclic antidepressant, mirtazapine works by increasing serotonin and norepinephrine in the brain. 

If you’re wondering whether mirtazapine can help with sleep, the answer is yes. Mirtazapine has various effects, including anxiety-reducing, antiemetic, and sedative effects. Because of its effects, mirtazapine is sometimes used off-label for different health problems, including anxiety, panic disorder, and even insomnia. 

For people with depression and trouble sleeping, mirtazapine may be a potential option. However, it is important to note that mirtazapine should only be used as directed by a healthcare provider and should not be taken without a prescription. Continue reading to learn more about mirtazapine, how it can help with sleep, and potential alternatives.

Mirtazapine for sleep

Mirtazapine is not approved by the FDA for the treatment of insomnia or other sleep disorders. However, mirtazapine is sometimes used off-label to help with sleep, as it has sedative effects that may help people fall asleep and stay asleep. In addition, it can increase REM sleep. For these reasons, a mental healthcare provider may recommend mirtazapine for people who experience insomnia, especially if it’s a symptom of depression. 

Off-label use refers to the use of a medication for a purpose that has not been specifically approved by the FDA. There are many medications that are commonly used off-label. Off-label use can be based on the experience of the prescribing doctor, clinical trials, or other research.

There have been several studies and research articles published on the use of mirtazapine as a sleep aid. One review collected and analyzed over 20 studies and found that mirtazapine improved sleep efficiency, total sleep time, and overall sleep quality. Another study reviewed the effects of mirtazapine on sleep in patients with major depressive disorder. Researchers found that mirtazapine caused a significant improvement in sleep quality and reduced depressive symptoms.

It is important to note that off-label use has not undergone the same level of testing and evaluation as FDA approved uses, and the safety and effectiveness of the medication for these uses may not be fully known. Before starting treatment, it is always important to speak with a healthcare provider about the potential risks and benefits of any medication.

How long does mirtazapine take to work

The amount of time it takes mirtazapine to work will vary by person. For sleep, mirtazapine typically starts producing sedative effects within 30 minutes to an hour after taking it. For this reason, people with insomnia often take mirtazapine before bedtime. It takes around two hours for mirtazapine to reach peak levels in the blood.

Overall sleep quality and energy levels may be improved within one to two weeks after starting treatment. For symptoms of depression, mirtazapine could take six to eight weeks or longer to start providing maximum benefits. 

Mirtazapine is usually taken as a long-term antidepressant medication. There have been no reported negative effects linked to the long-term use of mirtazapine. A healthcare provider will want to periodically assess the use of mirtazapine and ensure a person is using it as prescribed and not experiencing negative side effects. 

A doctor or healthcare provider may prescribe mirtazapine off-label to be taken on an as-needed basis. However, it’s usually prescribed as a daily medication for depression. It’s important to consult a healthcare provider and only take mirtazapine as prescribed. 

Benefits of mirtazapine as a sleep aid

Mirtazapine has several benefits as a sleep aid. It can help a person fall asleep faster and stay asleep throughout the night, improving sleep quality. 

Mirtazapine also has a variety of effects that make it useful for treating different mental health conditions. It can be especially useful for people with depression and chronic insomnia. However, it can also be used off-label in people with other psychiatric disorders, such as anxiety, panic disorder, and post-traumatic stress disorder. Mirtazapine is considered a safe drug for long-term use and is well-tolerated. 

Some people may find that they develop a tolerance for mirtazapine’s sedative effects over time. Meaning, mirtazapine may start to lose its effectiveness for sleep after long-term use. However, these reports are anecdotal; research hasn’t shown any concluding evidence for tolerance to mirtazapine’s effects. 

Mirtazapine dosage for sleep

The usual dosage of mirtazapine for the treatment of depression is 15 to 45 mg once per day. Because mirtazapine is used off-label for sleep, there is no official mirtazapine dosage for sleep. When used as a sleep medicine, mirtazapine is usually started at a low dose. Studies have shown that a single dose of 7.5 to 30 mg before bedtime may be appropriate for sleep. 

The appropriate dose of mirtazapine for the treatment of sleep may be different and will depend on different factors, such as age, weight, and medical history, as well as the severity of sleep issues. It is important to consult a healthcare provider to determine the right dosage of mirtazapine for sleep.

Mirtazapine comes as a regular oral tablet or orally disintegrating tablet (ODT). The ODT version of mirtazapine dissolves in the mouth and does not need to be swallowed with water. Research suggests that the ODT form of mirtazapine is more effective and causes fewer side effects than the regular mirtazapine oral tablet.

Mirtazapine side effects and warnings

The most common side effects of mirtazapine include drowsiness, dizziness, increased appetite, and weight gain. Mirtazapine may also cause serious side effects, including serotonin syndrome, eye problems, heart rhythm problems, manic episodes in people with bipolar disorder, seizures, and low sodium levels in the blood. Contact a healthcare provider if side effects occur, persist, or worsen.

Because mirtazapine is processed in the liver, it may interact with other medications that block or stimulate certain liver enzymes. These medications include phenytoin, carbamazepine, itraconazole, and ritonavir. Avoid taking mirtazapine with monoamine oxidase inhibitors, other serotonergic drugs, benzodiazepines, warfarin, or alcohol. 

Stopping the use of mirtazapine may also lead to withdrawal symptoms, such as irritability, anxiety, sweating, seizures, nausea, and confusion. 

It’s a good idea to speak with a doctor or healthcare provider for more information about the side effects and warnings of mirtazapine. Be sure to discuss other prescription medications you take and medical conditions you have before taking mirtazapine. 

Mirtazapine alternatives

There are several alternatives to mirtazapine that may be used to help with sleep, including prescription and over-the-counter (OTC) medications. Sleep medications for insomnia may include sedative-hypnotics, melatonin receptor agonists, and orexin receptor antagonists. Benzodiazepines or antihistamines may also be recommended for sleep. 

Medications used to treat sleep problems can differ in how they work, their potential side effects, drug interactions, and costs. You may need to try different medications to find the best option. 

Before starting a different medication, it’s important to do so under the guidance of a healthcare provider. You should also discuss the risk of using any medication with a healthcare provider before starting treatment. The appropriate treatment will depend on your overall health condition.

This is not a complete list of possible alternatives to mirtazapine for sleep. Other medications may be available over the counter or with a prescription to help treat insomnia symptoms. Consult a healthcare provider for help choosing the best option. 

It is important to note that the long-term use of prescription medications for sleep is generally not recommended, and nonpharmacologic treatments should be tried first whenever possible.

Natural alternatives for sleep

There are several natural alternatives that may be helpful for the treatment of insomnia. Some herbal supplements, such as valerian and chamomile, may have sedative effects and be helpful for sleep. It is important to speak with a healthcare provider before taking any herbal remedies, as they may interact with medications or have other risks.

Leading a healthy lifestyle and practicing good sleep hygiene can also help with sleep. Relaxation techniques such as deep breathing, muscle relaxation exercises, and meditation can help to calm the mind and body and promote sleep. Regular physical activity can help improve sleep, but it is important to avoid vigorous exercise close to bedtime. Maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and avoiding alcohol or caffeine before bedtime, can also help to improve sleep.

Bottom line

Mirtazapine is a commonly used antidepressant FDAapproved to treat clinical depression. Although it is not approved for the treatment of sleep disorders, mirtazapine has been shown to be an effective sleep medication due to its sedative effects. It’s best to consult a healthcare provider for medical advice before considering mirtazapine for sleep. A healthcare provider can prescribe an appropriate dosage or recommend other treatment options, depending on your treatment goals.