Mirtazapine (Remeron) for Anxiety and Sleep: What You Should Know

With anxiety affecting over 40 million American adults, finding effective treatment is crucial. At Next Step Psychiatry in Lilburn, we work with patients throughout Gwinnett County to find medication options that address their specific symptoms. One medication we sometimes prescribe is mirtazapine, sold under the brand name Remeron.

What Is Mirtazapine?

Mirtazapine is an atypical antidepressant—meaning it works differently than common antidepressants like SSRIs (Prozac, Zoloft). While SSRIs block serotonin reabsorption, mirtazapine actually triggers neurons to release more serotonin and norepinephrine, making higher amounts available in your brain.

FDA-Approved and Off-Label Uses

Mirtazapine is FDA-approved for treating major depressive disorder. However, doctors often prescribe it "off-label" for other conditions based on clinical experience and research, including:

• Generalized anxiety disorder (GAD)
• Social anxiety disorder
• Insomnia
• PTSD
• Panic attacks

Mirtazapine for Sleep

One of mirtazapine's notable effects is drowsiness—in clinical trials, about half of patients reported this side effect. This has made it a useful option for people who struggle with both depression/anxiety AND sleep problems. Studies show people with insomnia who took low doses of mirtazapine slept longer and woke fewer times during the night.

Dosing Information

Because mirtazapine can cause sleepiness, it's typically taken in the evening before bedtime. The usual starting dose for anxiety is 15 mg daily, which may be increased up to 45 mg based on response. For insomnia specifically, lower doses around 7.5 mg may be prescribed.

Finding the right dose takes time—be patient and work closely with your psychiatrist at Next Step Psychiatry to optimize your treatment.

How Long Until It Works?

You may notice improvements in sleep or energy within the first two weeks. However, full improvement in anxiety or depression symptoms typically takes 8-12 weeks. Don't stop taking the medication early, even if you don't notice immediate changes.

Common Side Effects

• Drowsiness (often decreases over time)
• Increased appetite and weight gain
• Dry mouth
• Elevated cholesterol levels
• Constipation

Is Mirtazapine Right for You?

There's no single "best" medication for anxiety—what works depends on your specific symptoms, medical history, and other factors. At Next Step Psychiatry, we conduct thorough evaluations to determine whether mirtazapine or another medication might help.