When mirtazapine arrived on the scene in the late 1990s, it was marketed to treat major depressive disorder (MDD). Better known as Remeron, the drug would also become known for its ability to treat some disorders “off-label,” from anxiety and post-traumatic stress disorder (PTSD) to migraines and insomnia.
Mirtazapine has even seen use as an opioid and cocaine withdrawal medication. Veterinarians also use it as an appetite stimulant for cats and dogs with anorexia from chronic kidney disease and other conditions.
Despite its reputation as a utilitarian medication, mirtazapine still carries the potential for abuse. Plus, ingesting large quantities of the drug can result in overdose, although those symptoms aren’t nearly as dangerous as other sedating medications like barbiturates and benzodiazepines.
However, when mirtazapine it is abused with alcohol, its sedative effects become more pronounced.
Read on to learn more about mirtazapine, its side effects, symptoms of addiction, and available professional treatment options.
What is Mirtazapine?
Decades before mirtazapine would be introduced in the U.S., Swiss researchers discovered the first antidepressant medication by accident in the 1950s. They were looking to formulate a medication to treat schizophrenia but stumbled upon a drug that altered the balance of neurotransmitters in the brain and endowed patients with feelings of euphoria. Soon an antidepressant called imipramine would be marketed under the brand name Tofranil. Many rival medications would arrive soon after.
Tofranil and other antidepressants of its era were called tricyclic antidepressants (TCAs) due to their three-ring chemical structure. It was only until the 1970s that tetracyclic antidepressants (TeCAs), which are closely related to TCAs, were introduced. TeCAs are named as such because of their chemical structure, which is four rings of atoms.
Mirtazapine, which is classified as a TeCA, was synthesized at a Netherlands-based pharmaceutical company and published in 1989. It gained its first approved use for MDD in the Netherlands in 1994. Two years later, it was introduced in the U.S. as Remeron. The same company released another version of the medication called Remeron SolTab in 2001.
The patent for the drug expired in 2004, and generic versions were made available. Though the drug is marketed under many brand names throughout the world, it is best known as Remeron.
Mirtazapine comes in the form of a tablet at 15, 30, or 45 mg (milligrams). The 15-45 mg tablets are also available in an orally dissolving form. The drug is usually taken once a day at bedtime. Mirtazapine works by increasing the production of serotonin and norepinephrine, the neurotransmitters in the brain that are responsible for influencing moods.
What differentiates mirtazapine from other antidepressants is that its side effects are relatively mild by comparison. What’s more, when compared to other drugs, it is relatively safe in the event of an overdose. Overdose from other antidepressant medications can produce severe cardiovascular effects, whereas mirtazapine does not, even when it is ingested at seven to 22 times the maximum recommended dose.
That still doesn’t mean that mirtazapine is free from abuse. On the contrary, it is still capable of producing side effects and withdrawal symptoms upon discontinuation. Like any substance, it can also cause damaging physical and psychological effects.
Signs and Symptoms of Mirtazapine Addiction
Mirtazapine is not as benign a medication as one might think. Actually, when it is ingested, it has sedative effects. That’s even more so when it is consumed with alcohol. Addiction to it is also possible, even with the perception that it is a “safe” drug.
Like with any other substance, the road to addiction often begins when a user displays a tolerance. That means the body gets used to the presence of a drug, so more is needed over time to achieve the desired effect.
Even if users take the medication as prescribed, they could still experience side effects. One sign of mirtazapine use are those side effects, which might be more pronounced with abuse. Mirtazapine side effects include:
- Dry mouth
- Increased weight and appetite
- Strange dreams
After tolerance to a substance is established, users will begin to develop a dependency on the drug. This occurs when the body adapts to the drug so that when use ceases, it produces symptoms of withdrawal. According to the National Alliance on Mental Illness (NAMI), Mirtazapine withdrawal symptoms include:
- Tingling of the skin
Finally, after someone has exhibited a tolerance and a dependency, they will begin to exhibit compulsive behaviors around obtaining the substance. This is when addiction has set in. When someone is hooked on mirtazapine, they will exhibit behavioral signs customary of any substance addiction.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), details 11 criteria for drug addiction. If you or a loved one has shown at least two of these symptoms with mirtazapine over a 12-month period, then a substance use disorder may be present:
- Taking more of the drug than intended, for a longer period than intended
- A persistent desire to stop taking drugs or repeated unsuccessful attempts to quit taking drugs
- A lot of time spent trying to get drugs, abuse them, and/or recover from their effects
- Intense cravings or urges for specific drugs
- Failing to go to work or school, or to meet obligations to friends and family because of drug abuse
- Ongoing drug abuse despite the physical, mental, emotional, or social problems associated with the abuse
- Giving up hobbies or activities to abuse drugs
- Ongoing abuse of drugs in inappropriate situations, such as using them in the morning before work, driving while intoxicated, or abusing drugs around children
- Experiencing physical or psychological problems due to substance abuse but continuing to abuse drugs anyway
- Physical tolerance, meaning the body needs more of the drug to experience the original level of intoxication
- Experiencing symptoms of withdrawal when trying to quit the drug
Other signs to watch for include:
- Changes in sleeping and eating patterns
- Failure to complete school assignments
- Failing to meet work deadlines
- Displaying a lack of energy or motivation
- Showing weight gain or loss
- Neglecting personal hygiene or appearance
- Socializing less
- Spending time with new friends
- Experiencing financial problems due to job loss or instability
- Spending all of one’s money on drugs
If any of these signs or symptoms of addiction sound familiar, then professional addiction treatment is vital if only to reverse the course of the substance abuse.
Mirtazapine Addiction Treatment
Oddly enough, a drug treatment tool can be an addictive agent in itself.
Mirtazapine is used to treat the opioid and cocaine withdrawal symptoms, yet, professional addiction treatment has an established set of therapies to help you get free of your mirtazapine abuse as well.
Professional treatment has been proven to be more effective than quitting a drug on your own because the onset of withdrawal symptoms can drive someone to relapse. Under professional care, you will receive the supervision, technical assistance, support, and tools to kick your addiction.
The first step in mirtazapine addiction treatment is medical detoxification. A medical team will assess the severity of your addiction and your overall physical health. After analyzing both factors, the team will come up with a personalized detox plan. This may include detox medications that will make your process safe and comfortable.
This slow tapering off process eases the discontinuation syndrome patients experience with antidepressants.
Since not all withdrawal symptoms are physical, a clinical staff consisting of therapists, case managers, and support staff will be on hand to provide you with the emotional support needed in detox.
In this phase, you will be under 24-hour medical supervision to ensure that you are responding well to treatment.
After detox, outpatient treatment is the most appropriate option for someone with solely a mirtazapine addiction. At this phase, you will be equipped with relapse prevention strategies while being free to attend to the daily obligations of your life.
However, if you abuse mirtazapine with alcohol or another substance, then it is highly recommended that you enroll in a residential treatment program, which will give you access to intensive treatment services. In residential, you will live onsite at the treatment center and be under 24/7 surveillance as you undergo a full-time slate of therapy.
How Dangerous is Mirtazapine?
Compared to other antidepressants, mirtazapine is relatively mild. However, this medication still can inflict dangerous and uncomfortable overdose symptoms. Overdose symptoms can include irregular or rapid heartbeat, severe dizziness, and fainting.
The Food and Drug Administration (FDA) also issued a black box warning regarding antidepressants like Remeron, in that short-term trials indicated that they increased the risk of suicidal thoughts in children, adolescents, and young adults, ages 18 to 24.
Mirtazapine should also not be taken with an MAO inhibitor.
- In 2016, 5.5. million prescriptions were written for mirtazapine.
- Between 2011 and 2014, an estimated one in nine Americans of all ages took at least one antidepressant medication in the past month, according to the U.S. Centers for Disease Control and Prevention (CDC).
The CDC also states that the use of Remeron and other antidepressants rose by 65 percent in the U.S. between 1999 and 2014.