[dr. bob]

Dr. Bob's
Psychopharmacology Tips

Mirtazapine side-effects

Date: Wed, 8 May 1996 01:02:22 -0300
From: Ivan Luiz de Vasconcellos Figueira <ilvf@Montreal.com.br>
Subject: Mirtazapine side-effects

The main side effects include sedation and weight gain.

Subject: Mirtazapine press release
From: eliot.gelwan@channel1.com (Eliot Gelwan)
Date: Fri, 13 Sep 1996 23:49:00 -0640

Here's a press release on mirtazapine I found:

West Orange, N.J., June 19, 1996 -- Organon today announced that the U.S. Food and Drug Administration (FDA) cleared for marketing Remeron (mirtazapine) for the treatment of depression...

"Remeron's ability to specifically target serotonin receptors is critical, since it minimizes common side effects patients typically find undesirable with most other agents, such as decreased sexual drive, nervousness and insomnia," said Dr. Paul Lammers, Medical Director at Organon...

Clinical Trial Data

The FDA clearance of Remeron is based on efficacy data from clinical trials involving approximately 3,000 people. Results from placebo and amitriptyline-controlled clinical trials supported the conclusion that Remeron provides effective relief of depression...

Side Effect Profile

Side effects observed in clinical trials were mostly mild and generally have not caused patients to stop taking Remeron. The commonly reported drug-related side effects were somnolence, increased appetite, weight gain and dizziness...

Date: 14 Aug 96 08:36:19 EDT
From: "Furey A. Lerro" <71544.3434@compuserve.com>
Subject: Mirtazapine granulocytopenia

It sounds good, but I am concerned about three cases of WBC problems (one of which was agranulocytosis) that were reported in John Schwartz's monthly psychiatric newspaper article on the drug.

Date: Sun, 18 Aug 1996 23:56:57 +0300 (EET DST)
From: Pekka Roponen <shrink@walrus.megabaud.fi>
Subject: Mianserin side-effects

Mirtazapine resembles closely mianserin, which has been marketed in this country since the begining of the 80s. It blocks serotonin 2 and 3 receptors so there should be very little nausea and sexual side effects. It is a powerful antihistamine so it should be sedating in the begining. Anticholinergic side effects should be minimal...

Date: Mon, 19 Aug 1996 00:05:29 +0300 (EET DST)
From: Pekka Roponen <shrink@walrus.megabaud.fi>
Subject: Mianserin granulocytopenia

In Finland, regular WBC monitoring is recommended within the 2 first months of treatment with mianserin because of 67 cases of granulocytopenia or agranulocytosis in Finland between 1981-94 (the population of Finland is only 5 million...). There have been about 20 fatal cases and also cases of pancytopenia (aplastic anaemia).

I always monitor leukocytes in the begining. It is claimed that if nothing happens during first 2 months, the risk after that is very low.

Date: Sat, 24 Aug 1996 21:27:36 -0400 (EDT)
From: David Tobolowsky <dmtmd@dcfreenet.seflin.lib.fl.us>
Subject: Mirtazapine side-effects

I just received in the mail the PDR supplement/ad for Remeron (mirtazapine).

Side effects include sedation, orthostatic hypotension, anticholinergic symptoms, and weight gain (the lack of which has been the selling point for newer antidepressants).

The risk of agranulocytosis/granulocytopenia is around 1/1000.

Date: Thu, 17 Apr 1997 14:17:02 -0700 (PDT)
From: Talia Puzantian <talia@itsa.ucsf.edu>
Subject: Mirtazapine side-effects

I have been involved in 5 or so cases in whom we have used this agent... It seems to be well tolerated, more sedating at lower doses (<= 15 mg/d) and less sedating at higher doses (> 30 mg/d); the main problem seems to be weight gain.

Date: Thu, 17 Apr 1997 20:52:47 -0500
From: bret burquest <bret@vnet.net>
Subject: Mirtazapine sedation

I tried it a few times and found that even the patients who needed sedation and sleep were usually uncomfortable with it. I did raise the dose once as I had read it would be less sedative. It didn't happen.

From: "Andy Cheshire" <andi@gte.net>
Subject: Mirtazapine weight gain
Date: Mon, 26 Jan 1998 21:56:09 -0500

I have found appetite stimulation to be a very pronounced side effect of mirtazapine! The package insert indicates that weight gain was clinically significant in 12% of patients in clinical trials (versus 2% for placebo). My guess is that due to the short time span of clinical trials (6 weeks) this is an underestimate of the true appetite stimulating effects of the medication.

Date: Wed, 08 Apr 1998 21:59:10 -0400
From: William Braden <braden@brown.edu>
Subject: Mirtazapine psychosis

About a year ago I described a case of a severely depressed woman in her sixties who became psychotic (masturbated with a toothpaste tube, stated I had instructed her to do this, etc) while on mirtazapine 45 mg daily (she had also just been withdrawn from lamotrigine).

Date: Wed, 8 Apr 1998 20:00:58 -0700
From: jpn@itsa.ucsf.edu (Jonathan Nye)
Subject: Mirtazapine hallucinations

I had a young patient with advanced AIDS (and probably some AIDS dementia) who developed visual hallucinations when I increased his mirtazapine from 15 to 30 mg.

Date: Mon, 25 May 1998 11:19:16 -0700
From: Charles Price <cprice@pol.net>
Subject: Mirtazapine electric shocks

Mention of the electric shocks in SSRI withdrawal syndrome reminds me of three cases I've had lately. I switched two patients from sertraline (one with concomitant lorazepam, one clonazepam) and another from imipramine to mirtazapine. The effect was positive but was punctuated by the electric shocks, which were not painful but very specific and noticeable.

From: "Sanjeev K Singhal MD" <sanju@vidnet.net>
Subject: Mirtazapine edema
Date: Mon, 31 Aug 1998 07:03:38 -0500

Both female patients whom I have tried treating with mirtazapine developed marked generalized edema in the 30-45 mg/day range. It decreased with dose reduction, but one was still troubled by the amount of edema at 15 mg, so she will now try 7.5 mg.

The official product info says edema occurs in 1% of patients...

--James S. Goodman, M.D.

I have used Mirtazapine extensively in all age group, including patients as old as 80 -90 yrs old. Have not seen any edema ocurring or worsening.

Date: Wed, 09 Sep 1998 19:43:14 -0600
From: "David M. Elwonger" <elwonger@usa.net>
Subject: Mirtazapine sedation

Unless they have had severe insomnia, I have started all of my depressed patients who I want on mirtazapine at 30 mg because so many refused to increase the dose to 30 mg after having excessive sedation on 15 mg. Interestingly, since I have started using 30 mg as starting dose, none of my patients have had to discontinue it because of side effects.

From: maniac3@webtv.net (Jim Glover, M.D.)
Date: Wed, 9 Sep 1998 19:49:24 -0700 (PDT)
Subject: Mirtazapine sedation

I routinely start at 30 mg HS, and most tolerate it fine. Some find it too sedating. One patient who slept most of the next day with 30 mg HS was able to tolerate 15 mg bid despite the fact that many find the lower dose more sedating because of its more prominent serotonin effect. So far I'm not impressed about the 15 mg HS dose being more sedating.

From: ConEmo@aol.com (Ron Podell, M.D.)
Date: Thu, 10 Sep 1998 00:31:56 EDT
Subject: Mirtazapine sedation

My practice is to start patients on 15 mg and tell them to expect sedation and that it will improve as we increase. That is a much better strategy for getting compliance with the 30 mg dose and helps them relax about the side effects. Starting at 30 mg is fine but doesn't allow for the psychological strategy above.

Date: Tue, 15 Sep 1998 22:39:45 -0400
From: jkels01@emory.edu (Jeffrey E. Kelsey, MD, PhD)
Subject: Mirtazapine weight gain

On Sept 15th, David M. Reiss, M.D writes

I have a 40-ish female who has chronic depression, been on essentially all the anti-depressants, and done best on mirtazapine (Remeron).

Three months ago she had a gastric bypass for obesity, has done well and lost considerable weight, but feels the Remeron is pushing up her appetite, which makes it difficult.

I would consider increasing the mirtazapine to 75-90 mg/day. Also check thyroid function and daily caloric intake/expenditure.

Date: Wed, 23 Sep 1998 22:07:34 -0600
From: David Elwonger <elwonger@usa.net>
Subject: Mirtazapine weight gain

Can your patient tolerate a higher dose of mirtazapine? Most of my patients have developed tolerance within a month for the appetite stimulation. This side effect becomes less and less a problem at higher doses. I have gone as high as 90 mg/d with some patients with good therapeutic benefit and *no* side effects. But perhaps those folks are *fast metabolizers*.

Date: Thu, 17 Sep 1998 19:20:11 -0600
From: "David M. Elwonger" <elwonger@usa.net>
Subject: Mirtazapine weight gain

I was not suggesting that a big dose of mirtazapine decreases the appetite. What I meant was that increasing the dose of mirtazapine may reduce the side effect of increase appetite caused at lower doses.

From: maniac3@webtv.net (Jim Glover, M.D.)
Date: Thu, 17 Sep 1998 21:29:54 -0700 (PDT)
Subject: Mirtazapine weight gain

In Europe where starting doses of 60 mg HS are routine, weight gain is not much of a problem.

Date: Fri, 18 Sep 1998 12:27:31 -0400
From: "Jeffrey E. Kelsey, M.D., Ph.D." <jkels01@emory.edu>
Subject: Mirtazapine weight gain

The idea being (at least in theory) that at higher doses the increased noradrenergic tone (secondary to alpha-2 receptor antagonism) would offset the increased appetite (presumed to be due to antihistaminergic effect). This is similar to the decreased sedation noted as the dose is increased to >= 30 mg/day.

From: "Sanjeev K Singhal MD" <sanju@vidnet.net>
Subject: Mirtazapine cramps
Date: Sat, 10 Oct 1998 10:22:37 -0500

A few months ago I put a patient on Remeron (mirtazapine). She called me two days later saying that she had developed severe cramps in her legs and stopped taking it. This lady has had many strange somatic symptoms so I did not take it that seriously. Yesterday another young patient mentioned the same problem.

Date: Sun, 11 Oct 1998 01:20:26 +0300
From: "Pekka V. Roponen, MD." <pekka.roponen@docpro.fimnet.fi>
Subject: Mirtazapine agitation

Remeron is closely related to mianserin (Tolvon). With mianserin, some patients develop paradoxical agitation, and the symptoms can include restless legs-like phenomenon, especially at night.

It is probably due to noradrenergic stimulation.

Date: Sun, 11 Oct 1998 12:04:43 -0400
From: "Eric Fier" <eric.fier@MCI2000.com>
Subject: Mirtazapine cramps

I've seen this on Remeron.

I'm treating a woman with lithium; she was asymptomatic until 7.5 mg mirtazapine was added -- then experienced the onset of severe leg cramps. She's so uncomfortable she's unable to sleep. It's worse on a higher dose (15 mg). It resolved upon discontinuation.

This topic is indexed under the following subjects:

Match: all terms any term

[ Psychopharmacology Tips | Interpsych | Mental Health Links ]

[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

URL: http://www.dr-bob.org/tips/split/Mirtazapine-side-effects.html
Original tips copyright 1994-98 original authors.
Web page copyright 1998 Robert Hsiung.