Dr. Bob's Psychopharmacology Tips

Mirtazapine to counteract side-effects of SSRIs

Date: Thu, 2 Oct 1997 18:47:09 -0400
Subject: Mirtazapine to counteract side-effects of SSRIs
From: gersteinp@juno.com (Paul S Gerstein)

On Thu, 2 Oct 1997 09:44:51 MST "Randy Buzan" writes:

Anyone know of any adverse interactions of mirtazapine with SSRIs? I'm thinking of adding it to assist with sleep...

Subject: Mirtazapine to counteract side-effects of SSRIs
Date: Fri, 3 Oct 97 00:33:04 -0000
From: Christopher D. Bojrab, M.D. <bojrab@iquest.net>

I have mixed mirtazepine with SSRIs in attempts to facilitate sleep (very effective), counteract GI effects (sometimes somewhat effective), and counteract sexual side effects (too soon to tell). To date, I have seen no adverse reactions.

Date: Thu, 22 Jan 1998 10:53:46 -0500
From: Haidee Quijano <hquijano@pol.net>
Subject: Mirtazapine to counteract side-effects of SSRIs

I feel confident enough to share with you my personal experience with the combination of SSRIs and Remeron (mirtazapine). Initially I substituted Remeron for trazodone to relieve insomnia in the initial stages of treatment and was pleasantly surprised to notice that most of my patients came back very pleased with the results. Significant mood change was noted almost in the first week of treatment, and insomnia relief was immediate. I also noted that in most cases there was hardly any need for upward titration of the SSRI, hence less if any associated sexual dysfunction. I cannot say for sure if that was a direct effect of the Remeron.

In 3 cases (all bipolar, depressed, on adequate therapeutic doses of mood stabilizers, with severe insomnia nonresposive to Ambien (zolpidem) and most sedatives) I got the opposite effect, almost an activating phenomenon.

One woman gained 30 lbs in 4 months. She hated going off Remeron because she had felt good for the first time in a long time, but her weight gain was reason enough for her to go off it.

Currently, I use the combination a lot with good results.

Date: Mon, 26 Jan 1998 12:59:42 -0500
From: Haidee Quijano <hquijano@pol.net>
Subject: Mirtazapine to counteract side-effects of SSRIs

I use 15 mg qHS of Remeron initially and titrate it up to 30 mg qHS. In cases where excessive sedation is observed at the initial dose, an increase to 30 or even 45 mg seems to do the trick. The rationale is that at higher doses the histaminergic effect is cancelled out by the noradrenergic one.

My colleague uses 7.5 mg qHS for his ADD kids and has found it very effective for insomnia as well as daytime anxiety.

From: M. Kirsten Miller, M.D., M.P.H. <KMillerx@aol.com>
Date: Sun, 5 Apr 1998 23:20:01 EDT
Subject: Mirtazapine to counteract side-effects of SSRIs

I have found Paxil (paroxetine) and Wellbutrin (bupropion) to be very helpful in combination with Remeron (mirtazapine). I've used Remeron fairly often:

• for Wellbutrin induced "activation"
• for SSRI induced sexual dysfunction -- with or without Wellbutrin.

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