Will Mirtazapine For Sleep Improve Sleep Quality?
What is mirtazapine?
The primary role of mirtazapine is not to treat sleep disorders. Mirtazapine is an antidepressant. The drug was developed in the early 90's by the Dutch pharmaceutical company Organon, and was first used to treat depression in 1994 in the Netherlands. Two years later, it appeared on the USA market under the brand name Remeron. Today, you will find it under Remeron brand name in most cases, but since the patent has expired, it is also available under other brand names.
It is an atypical antidepressant, which means that it works differently from most other antidepressant medication. It affects neurotransmitters (chemical messengers) in the brain by blocking some of the receptors, but exactly how mirtazapine affects the brain and body has not yet been fully proven. It's been shown to be effective in treating major depressive disorder in adults. If you take a look at the chemical structure, it is a tetracyclic antidepressant (TeCA) so it has the most similar characteristics with another atypical antidepressant – mianserin.
How does mirtazapine help you sleep better?
The use of mirtazapine to treat insomnia is considered off-label use. Off-label means that a particular drug is used to treat a medical condition for which it is not approved. But if clinical experience indicates that mirtazapine, for example, is useful for treating insomnia too, drug may be used off-label.
In the case of mirtazapine, doctors and pharmacists are unsure whether the drug directly affects the improvement of night's sleep or reduces the depressive symptoms and thus indirectly helps you sleep better. What is certain is that patients fall asleep quicker, night-time waking is not common, and that deep sleep lasts longer when mirtazapine is consumed regularly.
For all these reasons, doctors are sometimes reluctant to prescribe mirtazapine if you only suffer from insomnia and not depression. When they notice a link between insomnia and depression, then Remeron is among the drugs they will choose first.
Does mirtazapine have any side effects?
Although several hundred thousand people in the UK and more than five million people in the USA take mirtazapine, it has many side effects, like most antidepressants. It is generally safe, especially if taken in accordance with what your doctor advised. However do not be surprised if you experience one or more of the following side effects.
Increased appetite
One of the most common side effects is increased appetite. Also, many notice this after a few days, while mirtazapine has not yet begun to act on insomnia and depression. Increased appetite should subside after a while, but it is not uncommon for mirtazapine to cause weight gain if appetite does not decrease over time.
Dizziness
Virtually every new drug you start taking can cause dizziness. If you feel weak or unsteady, wait a few hours. In case it becomes recurring occurrence or even something that bothers you daily, consult a doctor. When vertigo occurs, stop taking the medicine immediately and seek professional help right away.
Anxiety
Although anxiety is one of the disorders for which mirtazapine is licensed in the UK, a number of patients taking mirtazapine only for insomnia report that they feel anxiety after beginning of treatment. Anxiety is not the only side effect, obsessive compulsive disorder is possible, although less frequently. Then one should consider whether off-label use makes sense or does more harm than good.
Confusion
There are many different definitions of confusion. If you notice that your thoughts are blurry and you can't think clearly, it's definitely a sign that you are confused. Other symptoms of confusion include disorientation and forgetfulness. Don’t jump to the conclusion that mirtazapine is the culprit, but it certainly can be.
Daytime drowsiness
Every now and then you will feel sleepy during the day. The reason may be accumulated sleep debt or a party you attended last night. But drowsiness is not a natural state and one should not live with a feeling of constant drowsiness. It can even be dangerous, for example when driving. Consider the reasons for being drowsy, and if there is no other obvious reason, it may be a side effect of the drug.
Restless Legs Syndrome
Willis-Ekbom disease, known as restless legs syndrome (RLS), often has no cause and is therefore also called idiopathic restless legs syndrome. When cause exists, some of the common ones are uremia, fibromyalgia, smoking and iron deficiency. Doctors also point out that new drugs can cause restless legs syndrome, usually over a limited period of time. After you stop consuming medication, things should return to normal.
Dry mouth
The medical term for dry mouth is xerostomia and when you read the instructions for 99% of medications you will find that xerostomia is a possible side effect. In most cases dry mouth is not caused by a salivary glands problem. Salivary glands should keep your mouth wet. Medications, aging and cancer therapy are the three most common causes. Dry mouth is something that should be addressed as soon as possible because it can affect the teeth and the entire digestive tract.
Diarrhea & nausea
We usually associate nausea and diarrhea to viral infections or food poisoning. The body can also recognize a new drug as something that needs to be eliminated. If diarrhea is not more frequent than 2 or 3 times during the first few days of taking mirtazapine, it may be considered a natural period for the body to become accustomed to the drug. If diarrhea and vomiting are violent and repeating every few minutes, see a doctor.
Headaches
About two hundred migraine attacks happen every day in the UK. More than 10 million adults in Britain suffer from various types of headaches and migraines, making it the most common neurological condition. Therefore, you are more likely to have a migraine attack than headache that is the consequence of taking mirtazapine. But if you have not suffered from headaches so far and they started when you have started taking mirtazapine, then there may be a connection.
Mirtazapine dosage for sleep – how much mirtazapine should I take for sleep?
When you go to the pharmacy you will find mirtazapine under many brand names. What is common to practically all generic versions are doses. Standard tablets and dispersible tablets can be found in doses of 15mg, 30mg and 45mg. There is also a liquid form on the market, and the only dose is 15mg per ml.
Your doctor will estimate how much you should take. You should strictly stick to the doctor's instructions. It is especially dangerous to take more than prescribed or to change doses every few days. In order for an antidepressant to work, a certain amount must accumulate in the blood and that is why you should not experiment with dosage.
Most experts believe that you should start with a lower dose and then increase it over time if necessary. When 45mg is taken daily, then it is usually recommended to divide it into two doses.
Is 7.5 mg of mirtazapine enough for sleep?
Several studies have shown that mirtazapine has a stronger sedative effect at low dose than at higher one. Therefore 7.5 mg of mirtazapine can be enough for sleep. When your doctor decides to prescribe you this medicine because of an insomnia, it will certainly be a lower dose than for depression. It is very likely that you will start at 7.5 mg or even lower dose and increase it later if you do not notice progress.
How long does mirtazapine take to work for sleep?
It is consumed by mouth, and to notice the change you need to wait between two and four weeks from the start of consumption. However, the biochemical and organic characteristics of each person are different, so do not be surprised if the drug starts to work faster or if you have to be more patient and wait longer than 4 weeks. Also, the data are based on the treatment of depression and anxiety, not insomnia, so the situation can be significantly different from one person to another.
Can you take mirtazapine occasionally for sleep?
No medication of this type should be taken only occasionally when you cannot fall asleep. Many people make the mistake of taking antidepressants and other sedatives from time to time, and then the effect is incomplete and can even be dangerous. There is a reason why such drugs are not over-the-counter (OTC) but are prescribed by a doctor. You can take Ibuprofen when needed, but not Remeron.
Who shouldn’t take mirtazapine?
Mirtazapine is contraindicated in many diseases and conditions. It is not recommended for people who have high blood cholesterol, as well as those with low amounts of sodium in the blood. If you have had a heart attack, stroke or other blood vessel disease, your doctor will probably not prescribe mirtazapine. Patients who have any of the mood disorders usually in the F30-F39 group should not take this medicine.
U.S. Food and Drug Administration labels Remeron with Black Box Warnings which means there are major risks. Suicide risk is the most common and that is why it is forbidden for all those with manic-depression or previous suicidal thoughts.
Mirtazapine should not be stopped abruptly as withdrawal symptoms are present. If someone is prone to addictions, due to the withdrawal crisis, the practitioner may choose a drug other than mirtazapine.
Before you take mirtazapine….
Mirtazapine and medicines in general should be the last resort and not something to reach for after a couple of sleepless nights. There is a possibility that the cause of the insomnia is different and that mirtazapine will not help you. Or that you don't need it at all, but that you can solve the problem with lifestyle changes.
Make sure you're not allergic to some components
Allergies can be potentially deadly. So check all the components first to make sure you are not allergic to any of them. However, it can always happen that you are allergic to a component without even being aware of it. If you experience an allergic reaction after taking mirtazapine, go to the emergency ward immediately.
Find the cause of your inability to sleep
There must be a reason for your inability to sleep. If you can't determine for yourself, then you need the help of a doctor. But first, think about your sleep hygiene. You can't expect night's sleep to be great if you eat junk food, smoke, you are physically inactive and watch TV before bed.
Make sure your bedroom is prepared for sleep
The bedroom must be our oasis. Temperatures should be optimal, which is between 18 and 20 degrees for adults. Then it should be dark and quiet. Don't forget to choose a mattress suitable for your sleep position, as well as a pillow. Choose appropriate duvet TOG for current season or buy all-season one.
Mirtazapine not working for sleep – what to do?
As the treatment of insomnia with the help of mirtazapine is off-label there is no guarantee that it will be successful. There is also a chance that insomnia will return during the withdrawal period and that mirtazapine is only useful while you are taking it regularly.
If you notice that the situation has not improved and you are still suffering from chronic insomnia, the only solution is to consult your GP. You may choose one of the many selective serotonin reuptake inhibitors that are also used for depression and anxiety. Or completely change your approach and prescribe another type of medicine.
Sleep hygiene is something that everyone should take care of, whether you suffer from insomnia or not. When you start taking treatment for insomnia it does not mean that sleep hygiene loses its importance, on the contrary.
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