Overcoming addiction is a significant challenge, partly due to the difficult withdrawal phase that comes with detoxing from addictive substances. One of the most common and distressing withdrawal symptoms is depression which occurs when detoxing from various substances. Depression can make the detox phase a huge struggle, but mirtazapine is one medication that can provide welcome relief. Understanding how mirtazapine works, its benefits and how to use it safely are crucial for ensuring its effectiveness and avoiding any potential risks.

What is mirtazapine?

Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA). It was first introduced in the 1990s as a novel treatment for major depressive disorder and has been in use ever since. In addition to depression, mirtazapine is also prescribed for a range of other conditions including anxiety disorders, panic disorders, post-traumatic stress disorder (PTSD) and the management of withdrawal symptoms in substance addiction treatment.

Mirtazapine is available under various brand names, including:

    Remeron

    Zispin
    SolTa
    Divaril
    Merdaten
    Beron
    Mirtalan
    Minivane
    Calixta
    Miro
    Minivane

Mirtazapine is administered orally, usually once a day, with the dose depending on the condition being treated, the severity of symptoms and the individual’s response to the medication. Its administration and dosing are critical aspects of its effectiveness and require professional management to ensure the best outcomes.

How does mirtazapine work?

Mirtazapine has a distinct mechanism that sets it apart from other antidepressants which is why it is often prescribed when other medication has failed. It primarily acts by blocking specific serotonin receptors (5-HT2 and 5-HT3 receptors) and alpha-2 adrenergic receptors. This blockade increases the release of serotonin and norepinephrine, two neurotransmitters vital for regulating mood and emotions.

By targeting these receptors, mirtazapine achieves a balance in the brain’s neurotransmitter levels, which is often disrupted in conditions like depression, anxiety and panic disorders. The increase in serotonin and norepinephrine levels helps to elevate mood, alleviate symptoms of depression and reduce anxiety, making it effective for a broad range of mental health conditions.

Mirtazapine’s action on these receptors also contributes to its sedative effects as it increases the release of histamine. This is particularly beneficial for patients who struggle with insomnia or sleep disturbances related to depression or anxiety.

Mirtazapine’s effectiveness in managing anxiety and panic disorders also comes from the way it changes the brain’s response to stress and panic triggers. By enhancing noradrenergic and serotonergic activity, mirtazapine can help stabilise the emotional and physiological responses to stress which reduces the frequency and intensity of panic attacks.

How is mirtazapine used in addiction treatment?

Dependence on drugs or alcohol is characterised by the brain’s adaptation to the presence of these substances, leading to changes in its chemistry and functioning. When the substance is no longer present because the individual begins to detox, the brain struggles to regain balance, resulting in withdrawal symptoms. These symptoms can be physical, such as nausea, sweating and tremors, or psychological, such as anxiety, depression and insomnia. The severity and duration of withdrawal symptoms can vary based on the substance used, the duration of use and the individual’s health.

Mirtazapine plays a crucial role in addiction treatment by alleviating withdrawal symptoms and making the detox process more manageable. As the drug increases the levels of norepinephrine and serotonin, mood swings and depression are stabilised while the blocking of specific serotonin receptors provides relief from anxiety. The sedative properties of mirtazapine, resulting from its antihistamine effects, can also help individuals experiencing insomnia during the detox process. By improving sleep quality, mirtazapine helps to support overall recovery by allowing the body to rest and heal.

Mirtazapine can be used during the detox for various substance addictions, including:

It is important to note that while mirtazapine can be effective in managing withdrawal symptoms, detox only addresses physical dependence. This is why mirtazapine-assisted detox should be part of a comprehensive rehab approach incorporating detox, therapy and aftercare services. Additional medications may also be needed to address other withdrawal symptoms, help prevent relapse or manage co-occurring conditions.

Mirtazapine side effects and health risks

Mirtazapine is a highly effective medication but it can also produce a range of side effects which can cause potentially serious issues. Understanding the possible mirtazapine side effects is important for anyone considering or currently using mirtazapine as part of their treatment plan.

Common mirtazapine side effects include:

Increased appetite and weight gain
Long-term use of mirtazapine is associated with significant weight gain and possible changes in metabolic parameters, which can increase the risk for diabetes, high cholesterol and heart disease, especially in individuals predisposed to these conditions.
Sedation and drowsiness
Due to its antihistamine effects, mirtazapine can cause marked sedation or drowsiness, especially at lower doses. While this can be beneficial for patients with insomnia, it may pose a risk for those who need to maintain alertness for activities such as driving or operating machinery.
Dry mouth
A common side effect experienced by many patients is dry mouth, which can be uncomfortable but is usually manageable with increased water intake or saliva substitutes.
Dizziness and lightheadedness
The blood pressure-lowering effects of mirtazapine can lead to dizziness or lightheadedness in some individuals.
Gastrointestinal symptoms
These include nausea, constipation and diarrhoea.

There are also more serious mirtazapine side effects which are less common:

Changes in mood or behaviour
Although rare, some individuals may experience worsening depression, suicidal thoughts or unusual behaviour changes. It is crucial to monitor for these symptoms and seek immediate medical attention if they occur.
Sleep issues
Mirtazapine has been linked to the development of nightmares, restless leg syndrome, sleep paralysis and sleepwalking.
Severe skin reactions
Rarely, mirtazapine can cause severe skin reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which require immediate medical intervention.
Liver damage
Mirtazapine has been associated with cases of liver damage, ranging from mild elevations in liver enzymes to rare instances of hepatitis. Patients with pre-existing liver conditions should use mirtazapine with caution and regular monitoring of liver function may be advised.
Severe neutropenia
A significant decrease in white blood cell count, specifically neutrophils, can occur, making the body more susceptible to infections. This condition, known as neutropenia, requires immediate discontinuation of mirtazapine and urgent medical evaluation.
Withdrawal symptoms
Although mirtazapine can help with withdrawal symptoms from other substances, abruptly stopping mirtazapine itself can lead to withdrawal symptoms such as dizziness, agitation and flu-like symptoms. It is important to taper off the medication under a doctor’s supervision rather than stopping it abruptly to avoid these.
Serotonin syndrome
This is a rare but potentially life-threatening condition that can occur if mirtazapine is taken in combination with other serotonergic drugs. Serotonin syndrome is characterised by symptoms such as fever, agitation, increased heart rate and confusion which need to be addressed immediately.
Risk during pregnancy and breastfeeding
Mirtazapine should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus. It is excreted into breast milk, so caution is advised when administered to breastfeeding mothers.

Understanding these potential health risks is vital for anyone considering mirtazapine as part of their treatment plan. Regular consultations with healthcare providers, ongoing monitoring of symptoms and side effects and individualised risk assessments are essential for safe and effective mirtazapine use.

Potential mirtazapine drug interactions

Mirtazapine can potentially interact with a number of drugs that can affect its effectiveness or cause dangerous side effects. These interactions may include:

    Monoamine oxidase inhibitors (MAOIs): Combining mirtazapine with MAOIs can lead to serious reactions, including serotonin syndrome.

    Serotonergic drugs: Concurrent use of mirtazapine with other serotonergic medications, such as SSRIs, SNRIs and certain pain medications like tramadol, can also increase the risk of serotonin syndrome.

    Central nervous system (CNS) depressants: Mirtazapine’s sedative effects can be amplified when used with other CNS depressants, including benzodiazepines, alcohol and certain antihistamines. This can lead to increased drowsiness, impaired cognitive and motor function and other sedation-related side effects.

    Warfarin and other anticoagulants: Mirtazapine can affect the blood levels of warfarin and other anticoagulants, potentially altering their effectiveness and increasing the risk of bleeding.

    CYP450 enzyme substrates: Mirtazapine is metabolised by liver enzymes in the CYP450 system, particularly CYP2D6 and CYP3A4. Drugs that inhibit or induce these enzymes can affect mirtazapine’s metabolism, leading to changes in its blood levels.

Discussing all medications and herbal supplements with a healthcare provider is vital for anyone starting mirtazapine. This ensures that potential drug interactions are identified and managed appropriately, allowing for the safe and effective use of mirtazapine in treating the intended conditions.

Get help for addiction today

If you or someone you know is struggling with addiction, it is crucial to seek professional help. Reaching out to your GP or a professional addiction treatment centre is always the first step towards recovery. These professionals can give you a full assessment and help you access a treatment plan that will work for you. They can also provide information about the use of medications like mirtazapine and how they can benefit you.

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FAQ’s

What is mirtazapine used for?
Mirtazapine is primarily used as an antidepressant to treat major depressive disorder, offering relief from symptoms such as sadness, loss of interest and sleep disturbances. It is also effective in managing anxiety disorders, panic attacks and insomnia due to its sedative effects. Many of these symptoms are also present during withdrawal so mirtazapine can be a useful aid during drug and alcohol detox.