Authored by 
Reviewed by Major depressive disorder (MDD) is a growing health concern, projected by the World Health Organization (WHO) to become the #1 disease by 2030.
Characterized by persistent low mood, loss of interest in activities, and other debilitating symptoms, MDD is often treated with medications like Mirtazapine. While Mirtazapine can be an effective tool, abruptly stopping it can lead to a range of unpleasant withdrawal symptoms.
Continue reading to learn about how to effectively manage the discontinuation of this antidepressant and minimize the discomfort of Mirtazapine withdrawal.
Table Of Contents:
What Is Withdrawal from Mirtazapine?
Mirtazapine belongs to a class of medications known as a group of tetracyclic antidepressants (TeCA), which work by inhibiting the central presynaptic alpha-2-adrenergic receptors, causing an increased release of serotonin and norepinephrine.
Withdrawal from Mirtazapine, also known as antidepressant discontinuation syndrome (ADS), is the range of symptoms that can occur when a person stops or significantly reduces their dosage within two to four days after drug cessation. The mean elimination half-life of Mirtazapine varies from 20 to 40 hours.
Withdrawal from Mirtazapine may vary according to:
- Severity of the disorder
- Length of the disorder
- Dosage
- Patientโs metabolism and mental health history
- Tapering schedule
- Use of other medications
- Age
It is believed that withdrawal symptoms from Mirtazapine and other antidepressants occur due to the body’s attempt to re-adjust to the absence of the medication’s influence on brain chemistry. This adjustment period can lead to a temporary deregulation of these neurotransmitters.
Mirtazapine Withdrawal Symptoms
Approximately 20% of patients experience antidepressant discontinuation syndrome after suddenly stopping or significantly lowering the dose after regularly taking the antidepressant for at least one month.
The symptoms typically appear within a few days of stopping Mirtazapine therapy and usually last two weeks or longer. Research helps summarize the symptoms of antidepressant discontinuation syndrome following the mnemonic FINISH in English:
Common Withdrawal Symptoms of Mirtazapine
- Flu-like symptoms
- Insomnia (disturbed sleep, vivid dreams/nightmares)
- Nausea
- Imbalance (vertigo, light-headedness)
- Sensory disturbances (electric shock-like sensations, dysesthesia)
- Hyperarousal (anxiety, agitation, irritability, etc.)
While many withdrawal symptoms are mild, some can be severe and require immediate medical attention. Although these severe symptoms are uncommon, patients must be aware of them. There have been no reported fatalities directly resulting from the withdrawal of Mirtazapine.
These withdrawal symptoms shouldnโt be confused with addiction. Unlike addictive drugs that cause euphoria or a โhigh,โ Mirtazapine works differently in the brain to regulate mood.
How Long Does It Last? Mirtazapine Withdrawal Timeline
Symptoms typically manifest between two and four days following the discontinuation of the medication and generally persist for one to two weeks. However, in some rare cases, they may last up to a year. Treatment with the same or a similar medication often resolves these symptoms within one to three days.
A chart for a standard timeline of withdrawal for mirtazapine is provided below:
| Period | Withdrawal Symptoms |
|---|---|
| 1-3 Days After Stopping | Mild anxiety, mild irritability, insomnia, nausea, dizziness, headaches. |
| 1-2 Weeks After Stopping | Increased anxiety, mood swings, flu-like symptoms, gastrointestinal issues, fatigue, sweating. |
| 2-4 Weeks After Stopping | More pronounced anxiety, depression, agitation, concentration issues, and sensory disturbances. |
| 1-3 Months After Stopping | Persistent mood swings, severe anxiety or panic attacks, possible return of depressive symptoms. |
| 3+ Months After Stopping | Symptoms typically begin to diminish, although some may experience lingering mild symptoms. |
Treatment and Management of Mirtazapine Withdrawal
The most effective strategy for managing this condition is prevention. Given that symptoms are generally mild and resolve on their own in most instances, providing patients with education is the first step.
The following strategies should include:
Gradual Dose Reduction
The discontinuation symptoms are associated with abrupt cessation of antidepressant medications, including tricyclic antidepressants.
One of the most effective methods to mitigate withdrawal symptoms is to gradually taper off the dose of Mirtazapine rather than stopping abruptly. This allows the brain and body time to adjust to the decreasing levels of medication. Research recommends gradually tampering with tricyclics over three months.
However, your healthcare provider should customize the specific tapering schedule and schedule regular check-ins.
Symptomatic Treatment
Healthcare providers may recommend treatments or medications to address distressing or disruptive specific Mirtazapine withdrawal symptoms. For example, sleep disturbances may be managed with sleep hygiene practices or, in some cases, short-term use of sleep aids. Nausea can often be managed with dietary changes or medication.
Monitoring for Re-emergence of Depression
It’s essential to differentiate between antidepressant discontinuation syndrome and the return of the initial psychiatric condition. ADS share many symptoms with depressive or anxiety disorders, which can lead to confusion in diagnosis.
Misreading these symptoms could lead to unnecessary and potentially harmful treatments. When switching medications, symptoms of ADS from the drug being phased out could be mistakenly attributed to the side effects of the new medicines.
Supportive Care
Emotional support from friends, family, or support groups can be invaluable during withdrawal. Additionally, counseling or therapy can provide coping strategies for dealing with emotional or psychological Mirtazapine withdrawal symptoms. It can be an essential aspect of care for individuals with underlying mental health conditions.
Planning for the Discontinuation of Mirtazapine
There are lots of reasons that people choose to stop taking their antidepressants, including:
- Mental health has got better
- Lack of effectiveness of the antidepressants
- Side effects became too unpleasant
- A personal preference to stop using antidepressants
Yet, planning and executing it carefully is crucial to minimize withdrawal symptoms. Here is a roadmap to guide you:
- Never stop Mirtazapine cold turkey. Schedule an appointment with your doctor.
- Follow gradual reduction in dosage over time.
- Be ready for potential withdrawal symptoms.
- Discuss management strategies with your doctor (i.e., OTC medications for nausea or sleep issues)
- Consider therapy, especially if you experience emotional or psychological withdrawal symptoms.
- Withdrawal can sometimes trigger a return of depression symptoms. Be prepared.
- Maintain open communication with your doctor.
Mirtazapine Withdrawal โ Key Takeaways
Due to variations in medication response, there’s no one-size-fits-all approach to managing antidepressant discontinuation syndrome. While tapering can help, it might not always prevent withdrawal symptoms.
The good news is that withdrawal symptoms are usually temporary and non-life-threatening and often resolve on their own. In instances of severe symptoms, reintroducing the medication and opting for a slower taper may be advised. If you are considering altering your antidepressant regimen, consult your healthcare provider to create a personalized plan that minimizes risks and ensures a smooth transition.
People Also Ask
How long does mirtazapine withdrawal last?
Mirtazapine withdrawal can last weeks or months, depending on factors like dosage and tapering plan. Consult a healthcare provider for a personalized timeline.
Do you need to taper off 7.5 mg of mirtazapine?
Generally, tapering is recommended for all dosages of mirtazapine to minimize withdrawal symptoms. Consult a doctor for specific advice about your dosage.
How long does it take for mirtazapine side effects to wear off?
The duration of mirtazapine side effects’ diminishment can vary, but many individuals notice a decrease within a few days to a few weeks after discontinuation or dosage adjustment.
Hope Without Commitment
Find the best treatment options. Call our free and confidential helpline
Most private insurances accepted
Page Sources
- Bains, N., & Abdijadid, S. (2023, April 10). Major depressive disorder. StatPearls - NCBI Bookshelf
- Jilani, T. N., Gibbons, J. R., Faizy, R. M., & Saadabadi, A. (2023, August 28). Mirtazapine. StatPearls - NCBI Bookshelf
- Gabriel, M., & Sharma, V. (2017). Antidepressant discontinuation syndrome. CMAJ: Canadian Medical Association Journal, 189(21), E747.
- Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry, 75(4), 336-346.
- Rizkalla, M., Kowalkowski, B., & Prozialeck, W. C. (2020). Antidepressant discontinuation syndrome: a common but underappreciated clinical problem. Journal of Osteopathic Medicine, 120(3), 174โ178.
- Stopping antidepressants | Royal College of Psychiatrists. (n.d.). www.rcpsych.ac.uk. Stopping antidepressants
- Berigan, T. R. (2001). Mirtazapine-Associated Withdrawal Symptoms: A Case Report. Primary Care Companion to The Journal of Clinical Psychiatry, 3(3), 143.
- Henssler, J., Heinz, A., Brandt, L., & Bschor, T. (2019). Antidepressant Withdrawal and Rebound Phenomena. Deutsches รRzteblatt International, 116(20), 355-361.