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Mirtazapine Uses: Remeron Mechanism Of Action

Last Updated: February 22, 2024

Authored by Sharon Levy, MD, MPH

Reviewed by Dr. Ash Bhatt

Mirtazapine use for depression is an effective remedy that moderates the levels of certain neurotransmitters, but mirtazapine can be effectively used for other conditions. Remeron off-label uses vary from anxiety conditions to problems with sleep and substance abuse. Continue reading to learn the whole scope of mirtazapine uses.

What Is Mirtazapine Used For?

The U.S. Food & Drug Administration (FDA) approved Remeron medication use for major depressive disorder or MDD in adult patients. The use of Remeron for depression is efficient because it increases the production of norepinephrine and serotonin, the primary neurotransmitters that influence cognition and mood. Mirtazapine use improves feelings of well-being and mood, restoring the balance between neurotransmitters.

Remeron Off-Label Uses

Studies show that Remeron has off-label uses, being also effective in treating conditions such as anxiety disorders, depressive disorders other than major depression, pain disorders, substance use disorders, and more.

Here is a detailed list of Remeron off-label uses:

Anxiety disorders – Panic disorder
– Post-traumatic stress disorder
– Generalized anxiety disorder
– Social anxiety disorder
– Obsessive-compulsive disorder
– Combat-related posttraumatic stress disorder
Depressive disorders other than major depression – Dysthymia
– Menopausal depression
– Poststroke depression
– Depression due to human immunodeficiency virus
– Anxiety and depression in patients undergoing transplantation
– Geriatric depression
– MDMA-induced depression
Pain disorders – Tension-type headaches
– Cancer pain
– Fibromyalgia
Substance use disorders – Alcohol dependence
– Amphetamine dependence
– Methamphetamine use disorders
Other conditions – Schizophrenia
– Hot flashes
– Sleep disorders
– Sexual disorders
Weight loss

Remeron use for these medical conditions shows results because of its anxiolytic, antiemetic, sedative, and appetite stimulant effects.

Sleep Problems

Mirtazapine for sleep-related issues has shown significant results in a study made on 130 patients suffering from depression and insomnia. The study results proved the efficiency of mirtazapine use as a sleep aid in offering patients improved sleep quantity and prolonged slow-wave sleep.

Remeron for insomnia shows promise at both mirtazapine 15mg and 30mg as a daily dose administered for two weeks.

Anxiety Disorders

Scientists discovered that Remeron for anxiety could significantly improve symptoms of GAD, PTSD, anxiety with comorbid depression, social anxiety, and panic disorder. The use of Remeron show, in some cases, better results compared to the current standard treatment options, which include the use of SSRIs and tricyclic antidepressants.

remeron use for low appetite

Low Appetite

Although most of the patients see Remeron weight gain as a side effect they would like to avoid; there are those who actually benefit from this. Some doctors prescribe Remeron for appetite stimulation in patients suffering from various medical conditions. Recent research has determined that the use of Remeron can improve appetite in patients with advanced cancer, suffering from weight loss, and anorexia. There are encouraging results of mirtazapine use for patients with advanced dementia who developed issues in eating behaviors that have led to weight loss and anorexia.

Mirtazapine Warnings & Contraindications

75% of mirtazapine is excreted by the kidney. Therefore, the risk of decreased clearance of Remeron is higher in patients with impaired renal function and the elderly. Caution is needed when the drug is used by such patients. Remeron side effects in elderly also include over-sedation and confusion.

There are also Remeron contraindications with other antidepressants, such as MAO inhibitors. Remeron should not be used with Zyvox (linezolid), Eldepryl (selegiline), Parnate (tranylcypromine), Nardil (phenelzine) or Marplan (isocarboxazid). After stopping the treatment with mirtazapine, the patient should wait at least 14 days before starting any of these MAO inhibitors, to avoid serious Remeron interactions.

man wondering how remeron works

How Does Mirtazapine Work?

Mirtazapine mechanism of action manifests by an increase in activity of serotonin and noradrenaline in the brain, with their simultaneous release from the nerve cells to lighten the mood. Scientists believe that when depression occurs, the level of the released neurotransmitters is low.

The drug’s sedative effects also help people with insomnia or sleep problems, having a positive impact on sleep duration and continuity. In this case, the drug works by lessening the hyperarousal (responsible for preventing people from falling asleep) and increases the stages of slow-wave, restorative sleep.

Thanks to the mirtazapine mode of action and sedating effect, the drug can also prevent initial anxiety from aggravating. As an alpha-2 antagonist, Remeron blocks certain postsynaptic serotonergic receptors that are responsible for mediating excessive anxiety when they are stimulated with serotonin.

time of how fast remeron start working

How Long Does Mirtazapine Take To Work?

Mirtazapine onset of action is rapid, as the drug is quickly absorbed after administration. Plasma concentrations reach peak levels two hours after ingestion. The half-life of this drug varies between 20 and 40 hours.

Significant improvement with Remeron will be seen between two to four weeks after the start of the treatment. The patient should not stop taking the drug if Remeron MOA does not bring the expected results at the beginning. The duration of the treatment plan varies, but it lasts for at least six months on average.

Considering mirtazapine MOA, appetite, energy, and sleep will be improved within the first two weeks, and this is the first sign that the drug is starting to work. Lack of interest in activities and depressed mood will need six to eight weeks to improve fully.

Stay Informed

Doctors should correctly and efficiently inform the patient about how to use Remeron and its mechanism of action and possible side effects. An abrupt quitting of mirtazapine can result in intense Remeron withdrawal symptoms. With specialized help, this transition can be made gradually, by decreasing the dosage. This would result in an extended detox period. Centers for addiction treatment can help the patient better cope with the withdrawal and related conditions. These facilities offer short-term and prolonged alcohol and drug addiction treatment to meet the needs of different patients.

Page Sources

  1. Alam A, Voronovich Z, Carley JA. A review of therapeutic uses of mirtazapine in psychiatric and medical conditions. The Primary Care Companion for CNS Disorders. 2013; 15(5): PCC.13r01525. doi:10.4088/PCC.13r01525. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907331/.
  2. San L, Arranz B. Mirtazapine: only for depression? Acta Neuropsychiatrica. 2006; 18(3-4): 130-43. doi: 10.1111/j.1601-5215.2006.00143.x. https://www.ncbi.nlm.nih.gov/pubmed/26989965.
  3. Dalal S. Effects of Mirtazapine on Appetite in Advanced Cancer Patients. M.D. Anderson Cancer Center. 2007. https://clinicaltrials.gov/ct2/show/NCT00488072.
  4. Jilani TN, Saadabadi A. Mirtazapine. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. https://www.ncbi.nlm.nih.gov/books/NBK519059/.
  5. Lavergne F, Berlin I, Gamma A, Stassen H, Angst J. Onset of improvement and response to mirtazapine in depression: a multicenter naturalistic study of 4771 patients. Neuropsychiatric Disease and Treatment. 2005; 1(1): 59–68. doi:10.2147/nedt. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2426820/.

Published on: February 21st, 2024

Updated on: February 22nd, 2024

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Dr. Ash Bhatt

Throughout his professional life, Dr. Bhatt has been conferred with diplomate status by the American Board of Psychiatry and Neurology, certifying him in both adult and child/adolescent psychiatry. His experiences in emergency rooms, frequently encountering patients with simultaneous health and addiction issues, directed his attention to these specific fields.


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