Mirtazapine (Remeron)

Basic Instructions

· The dose of this medicine will be different for different patients

· We are going to start you at ____ mg once a day, preferably in the evening just before you go to sleep

· Increase by _____ mg/day every two to four weeks (as tolerated) until 100% better to a maximum of 45 mg/day

· Common side effects tend to go away within 1-2 weeks after starting or after each dose increase, as your body adjusts to the medicine

· This medicine may increase your weight. Your doctor should check your weight on a regular basis (e.g. monthly) while you are using this medicine

· This medicine may cause excess sedation

Mayoclinic.org

Side effects

All SSRIs work in a similar way and generally cause similar side effects. However, each SSRI has a different chemical makeup, so one may affect you a little differently than another. Most side effects may go away after the first few weeks of treatment, but talk to your doctor if any side effects are too troublesome for you.

Side effects of SSRIs may include, among others:

· Constipation

· dizziness

· drowsiness

· dry mouth

· increased appetite

· weight gain

· Abdominal or stomach pain

· abnormal dreams

· back pain

· dizziness or fainting when getting up suddenly from a lying or sitting position

· increased need to urinate

· increased sensitivity to touch

· increased thirst

· low blood pressure

· muscle pain

· nausea

· sense of constant movement of self or surroundings

· trembling or shaking

· vomiting

· weakness

Read the package insert for additional side effects, and talk to your doctor or pharmacist if you have questions.

Safety concerns

· Serotonin syndrome. It occurs when two medications that raise serotonin are combined. These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort. Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination and rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.

· Drug interactions. When taking an antidepressant, be sure to tell your doctor about any other medications or dietary supplements you're taking. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal remedies.

· Increased Chance of Infections. This medicine can temporarily lower the number of white blood cells in your blood, increasing your chance of getting an infection. If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection or if you have a fever or chills, sore throat, sores in the mouth, lower back or side pain, or painful or difficult urination.

Suicide risk and antidepressants

· Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

· Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

· Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Finding the right antidepressant

· Each person may react differently to a particular antidepressant and may be more susceptible to certain side effects. Because of this, one antidepressant may work better for you than another, or your doctor may prescribe a combination.

· When choosing an antidepressant, your doctor will take into account your particular symptoms, what health problems you have, what other medications you take, what has worked for you in the past and what has worked for a close relative with depression.

· Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of special blood tests may offer clues about how your body may respond to a particular antidepressant. The study of how genes affect a person's response to drugs is called pharmacogenomics. However, other variables besides genetics can affect your response to medication.

· Typically, it may take several weeks or longer before an antidepressant is fully effective and for initial side effects to ease up. You may need to try several dose adjustments or different antidepressants before you find the right one, but hang in there. With patience, you and your doctor can find a medication that works well for you.

Stopping the Medication

Do not stop treatment abruptly. Also, avoid missing several doses because it can cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

Withdrawal-like symptoms can include:

· Nausea

· Dizziness

· Lethargy

· Flu-like symptoms