(Remeron) Mirtazapine: Why Low Dose Mirtazapine Differs from Mirtazapine 15 mg and Mirtazapine 30 mg

In this video, we delve into the distinctions between low-dose Mirtazapine and the standard doses of Mirtazapine 15 mg and Mirtazapine 30 mg, shedding light on their unique effects and considerations for patients.

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The video provides an overview of Mirtazapine (Remeron), primarily used as an antidepressant with notable sedative effects, making it useful for insomnia. Compared to SSRIs, Mirtazapine has fewer sexual and gastrointestinal side effects, though it can lead to weight gain. FDA-approved for major depression, it's also used off-label for anxiety disorders, nausea, and appetite stimulation, particularly in cancer patients undergoing chemotherapy. Mechanistically, Mirtazapine acts on histaminergic, serotonergic, and noradrenergic pathways, blocking H1, 5-HT2A, 5-HT2C, 5-HT3, and alpha-2 adrenergic receptors. Its dosing regimen involves low doses primarily as an antihistamine, with increasing serotonergic effects at higher doses, such as Mirtazapine 15 mg and Mirtazapine 30 mg. Optimal doses for depression range from 15 to 30 mg, showing faster onset than SSRIs but may take up to four weeks for maximal effects. Mirtazapine also improves sleep latency and duration but may disrupt sleep at higher doses. Notably, it shows efficacy in reducing methamphetamine use disorder and risky sexual behaviors. Overall, Mirtazapine is considered a first-line antidepressant, especially for patients with insomnia, despite the potential for weight gain and sedation, offering advantages over other antidepressants in certain clinical contexts.

#pmhnp #psychnp #psychopharmacology #psychiatryresident

[steveath]

I was prescribed mirtazapine on Monday. I have chronic anxiety, insomnia, pain & RLS. The next day, after a reasonable night’s sleep, I actually felt different. The day after, I was feeling almost a bit more relaxed & today, I feel more improvement. I am 72 & existing, not living, for the past 2 - 3 years. I have little faith in doctors & do not like taking meds.
The doctor I saw was a general family consultant here in Spain. He is the 1st doctor who has actually listened to me & not sat in front of a screen, typing away. I now feel that there is a possibility to recover from the awful place I am in.
I have hope.

[CarsonClayOfficial]

And if somebody is moving from 15mg to 30mg their H1 receptors have probably already greatly desensitized. So it appears the higher doses are less sedating

[ryanmcdarby]

There's so much anecdotal evidence out there that Mirtazapine at 30mg and above can be extremely stimulating and even cause insomnia, that I don't think we can honestly say "it's not less sedating at higher doses". Being on 30mg, for me, was a completely different experience to being on 15mg - the polar opposite in fact. And this seems to be incredibly common. Why there's no imperical evidence to support something that's such a common experience seems very strange. A similar issue is the common claim that Mirtazapine doesn't blunt emotions for many people like SSRIs and SNRIs are known to do. Again, the imperical evidence isn't there, but when you start talking to people about their experiences you'll find dulling of emotions is extremely prevailant with this drug. There are even videos on YouTube of doctors claiming, that unlike SSRIs, the mechanism of Mirtazapine doesn't cause a loss of emotions and/or sex-drive. I personally think this is just theoretical and the research simply hasn't been done.

[bmitidieri]

Congratulations on your work! Keep it up!

If possible, post more videos on cognitive/ psychoanalytical models.

[harmony]

How does more noradrenaline help with anxiety?

[OfficialRogue]

As a patient with bipolar disorder who has taken Quetiapine (for a year+), would you say that Mirtazapine has quite a similar profile when it comes to the experienced effect? (due to high H1 affinity (sedation & weight gain / metabolic effects, insomnia treatment starting from lower doses), anti-depressant / serotonergic effects at higher doses, anxiolytic effects, possible cardiac/QT side effects, increases liver enzymes, etc.
For someone who had little luck with Quetiapine (due to insufficient anti-depressant efficacy, and dropout due to weight gain and sedation side effets (esp daytime & difficulty waking up) + building tolerance to the sleep-promoting effect over time, + concerns over liver issues (having developed steatosis from the weight gain)), Mirtazapine doesn't look like it would be a much different experience no?

Thank you for these videos, always educational for me as a patient.

[philippeansaloni]

I take Guanfacine and Bupropion.my nurse suggested Mitrazapine for my insomnia at 7.5mg, now seeing that it is an a2 antagonist could it make Guanfacine less effective? I hope thats not the case because Guanfacine has been a life changer

[lululove]

Would you have to taper 3.75 mg..take for horrible insomnia with pain and also underweight.

[notionzero]

This is from Google; Can mirtazapine cause chronic fatigue?
It's interesting to note that mirtazapine may cause 'sleep disorders', with fatigue also being a common side effect. While mirtazapine may help you to sleep better while you're taking it, it's well recognised that insomnia can develop after stopping taking the drug. My Question; Hey, sry to ask This here but i need help, i took mirtazapine for 2 months 30mg Then did the stupidity to stop abruptly, which medication can i take to reverse that fatigue effect? Plz anything would help, please answer freely, i promise to ask My doctor first

[EmotionalTrance]

I have a fat Belly from mirtazapine 7.5mg

[broken-dimension-remind]

Not trying to troll, but have you reflected on the truth and value of receptor theory? This channel seems to go quite hard, in the spirit of Stahl. As a purely clinical psychiatrist I have started to view pharmacodynamics as mainly a way to "professionalize" our niche of the medical field, without actually being that usefull in daily practice. I care about outcomes, not receptors. My knowledge of the differences in receptor profiles has probably never benefited my patients apart from avoiding side effects (anticholinergics etc). The only thing it really has done is give me a way to sound smart. Regarding actual psychiatric treatment effect nothing is gained from knowing what 5-HT receptor subtype or even which monoamine a particular drug targets. I would love to be proven wrong.

[maestro]

The idea that Mirtazapine has value for treating meth addiction is just mind-boggling to me. That such a strong sedative could help cravings for one of the strongest stimulants known just feels completely counterintuitive to me. At least based on the substitution model of opioid addiction treatment with mu agonists, I would have expected only something like modafinil or pitolisant to have any value. Almost reminds me of how thiazide diuretics are used to treat nephrogenic diabetes insipidus or how ativan works for catatonia.

[ginakendrick]

Been on it 25 years. 15 mg . But… I want off. Heard it’s going to be hard very hard as YouTubers have mentioned. I bought a scale that will weigh out in 10 % A month increments for reducing. I originally went on it for. Depression. Absolutely no weight gain

[CarsonClayOfficial]

Love that meta-analysis. Vortioxetine ranked more effective than clomipramine. What a joke

[plockacherrys]

gotta comment to never get this as mono