Remeron (Mirtazapine) is a tetracyclic antidepressant (TeCA) drug that works primarily by raising levels of norepinephrine and serotonin in the brain. It is generally used to treat major depressive disorder, but is also sometimes prescribed as an anxiolytic (anti-anxiety), antiemetic, hypnotic, and appetite stimulant medication. Off label uses for Remeron include: social anxiety disorder, obsessive-compulsive disorder, PTSD, insomnia, and to increase appetite in those who are underweight or have eating disorders.
In regards to effectiveness as an antidepressant, a major meta-analysis study from 2009 found Remeron more effective than all SSRI’s, SNRI’s, and Bupropion (Wellbutrin). Despite the fact that its efficacy was considered superior to all other second-generation antidepressant medications, the degree to which it was superior was not statistically significant compared to Lexapro, Paxil, and Effexor. Other off-label uses for Remeron include: helping curb symptoms of drug withdrawal, treating the negative symptoms of schizophrenia, reducing Parkinson’s disease psychosis, and to treat anorexia in cats.
Although Remeron can work very well for pulling someone out of a deep depression, others find its side effects to be intolerable. Perhaps the most difficult side effect to cope with is the significant increase in appetite and cravings for carbohydrates (i.e. junk food). The major increase in appetite tends to result in significant antidepressant-induced weight gain among certain individuals.
Others who take this drug find it makes them feel too sleepy and/or it eventually “poops out” and stops working. If you have given this medication a shot, but no longer want to be on it, read below so that you have a general idea of what to expect during the withdrawal process.
Factors that influence Remeron withdrawal
When coming off of any antidepressant, there are going to be various factors that influence both the severity and duration of withdrawal symptoms. These factors include things like: the time span over which you took Remeron, your dosage, how quickly you tapered when discontinuing, as well as your individual physiology.
1. Time Span
Over how long did you take Remeron? In general, those who took it for an extended period of time may take longer to readjust to functioning without the drug. When you take an antidepressant every day for years, your body and brain become reliant on it for functioning. Those who took Remeron for shorter periods of time will likely have less severe withdrawal symptoms and shorter durations of withdrawal than long-term users.
2. Dosage (15 mg to 45 mg)
Most people start taking Remeron at a dose of 15 mg per day before going to sleep. Although there isn’t a relationship between dosage increase and effectiveness for treating major depression, some patients may benefit from increased dosages. A psychiatrist may have some people titrate up to a maximum dosage of 45 mg per day.
It is thought that individuals taking the minimum dose of 15 mg should have an easier time withdrawing than those taking higher doses (e.g. up to 45 mg). If you are on a higher dosage, you will likely need to conduct a gradual taper in order to minimize withdrawal symptoms.
3. Cold Turkey vs. Tapering
Quitting any antidepressant “cold turkey,” including Remeron is thought to yield more severe withdrawal symptoms than if you conduct a gradual taper. By tapering, you allow your body and brain to gradually adjust to changes in dosage. For long-term users, it is recommended to taper at a rate of 10% of your current dose per month. Therefore if you were at 45 mg, you would taper down to 40.5 mg to start, then after another month drop to 36.45.
When tapering you don’t have to necessarily be exact with your tapers, but if you round the dosage down, you may notice more severe withdrawal effects than you planned on. As you can see, a taper rate of 10% may take some individuals an extended period of time to successfully reach 0 mg. The whole idea is to taper slowly so that you don’t shock your nervous system by quitting cold turkey – which can result in severe discontinuation effects.
If you feel as though you can handle a quicker withdrawal rate than 10% per month, that’s your decision. Everyone will react differently to withdrawal and some people may not be as sensitive to the discontinuation effects as others.
4. Individual Physiology
Much of the withdrawal symptoms are based on individual circumstances. Since everyone is unique, each person tends to recover at a different rate and symptoms are subject to variation. One person may engage in mild exercise, eat healthy, get plenty of sleep, and stay hydrated which could facilitate a quicker recovery than someone who doesn’t exercise, get proper sleep, and dwells on their withdrawal symptoms.
During the withdrawal process it is important to avoid comparing your recovery to that of other people as each person usually recovers at a different rate. Additionally it should be noted that some individuals transition to a new antidepressant and/or are taking other drugs and may not experience as much of a withdrawal as a result of other medications.
Remeron Withdrawal Symptoms: List of Possibilities
Below are a list of symptoms that have been reported during discontinuation from Remeron. Keep in mind that you may not experience all of the symptoms listed below during your withdrawal. The withdrawal process is highly individualized in regards to what symptoms you will experience, their severity, as well as how long they last before you recover.
- Anxiety: Upon discontinuation, many people have reported major spikes in anxiety. The anxiety that you experience during withdrawal is likely linked to changes in the neurotransmission of serotonin and norepinephrine as a result of taking this drug. Many individuals report feeling anxious for an extended period of time after their last dose. Just know that the anxiety will eventually diminish as your brain reverts back to drug-free functioning.
- Appetite decrease: As was mentioned, this is a drug that can significantly boost your appetite. When you stop taking it, your appetite will likely return to what it was prior to taking this drug. It is this natural decrease in appetite that will lead you to lose most of the weight that you gained in relatively short order.
- Concentration problems: Many people report feeling spaced out and/or foggy thinking when initially quitting this medication. You may have trouble focusing on work-related tasks and/or schoolwork when coming off of this medication. As time passes, your concentration should come full circle and return to normal.
- Confusion: Some individuals become confused as to what they are experiencing during withdrawal. This confusion is generally a result of poor combination and cognitive function. The confusion and fog should eventually pass, but it may take some time.
- Crying spells: It is common to feel increasing depression when you withdraw from this medication. The increases in depression and other mood swings can lead to crying spells. During these spells many people feel completely hopeless about their situation. The reality is that they will eventually recover and these will subside.
- Depersonalization: This symptom involves feeling unlike your normal self, almost as if you have become a zombie and/or are panicking because you think you’ll never feel how you did prior to taking this drug. It can be very uncomfortable to feel depersonalized, but it’s generally a result of chemical changes that will change over time.
- Depression: Most people experience increases in depression when they withdraw from an antidepressant. In fact, the depression a person experiences in withdrawal is sometimes more severe than it was prior to their first dose of Remeron. This is due to the fact that when you withdraw from an antidepressant, a new chemical imbalance is created because your brain is now trying to function soberly after being fed a drug for weeks, months, or years. This new imbalance should correct itself, but it will require some time.
- Diarrhea: It is possible to experience diarrhea as a symptom when coming off of this drug. In order to minimize this particular symptom, a slow taper is recommended. Additionally consider taking some over-the-counter Imodium if it gets out of control.
- Dizziness: This is one of the most common symptoms that people experience during withdrawals. You may feel varying degrees of dizziness for weeks, or in some cases, months on end. The dizziness tends to be more extreme during the first few weeks of withdrawal. It can manifest as vertigo too in more extreme cases.
- Fatigue: It is common to feel lethargic and excessive tiredness when coming off of an antidepressant. The fatigue is usually due to the brain still not having fully rebounded back to normal after your last dose. The fatigue can last for quite some time, but your energy should return over time.
- Flu-like symptoms: Reports of flu-like symptoms and/or allergies upon discontinuation are fairly common. These symptoms tend to be intensified with “cold turkey” withdrawals and can be minimized if withdrawal is conducted gradually.
- Headaches: Having headaches is very common when a person first quits this medication. These headaches may last weeks, but affect some individuals for months after their last dose. Although these can be a nuisance, they usually subside once a person’s level of arousal and anxiety drops.
- Heart palpitations: Do you have sensations that your heart is pounding extra loudly or racing? These sensations are known as palpitations and are somewhat common during withdrawal. These can exacerbate anxiety and vice-versa so if you experience them, it is better to accept them as merely being a symptom rather than something to panic about.
- Hypomania: This is considered a lower-grade form of mania (i.e. mood elevation) exhibited by individuals with Type-2 Bipolar disorder. There have been cases of hypomania reported during withdrawals from Remeron.
- Insomnia: After quitting this drug, a lot of people struggle with falling asleep at night. A thing many people have found helpful is to take melatonin prior to bedtime. Additionally consider engaging in some sort of relaxation exercise such as deep breathing or meditation to mitigate insomnia.
- Irritability: When a person goes through withdrawal, they become highly sensitive and are prone to mood swings. A very common mood for a person to experience is that of irritability or the feeling that everything is a nuisance or bother. The person doesn’t want to feel this way, but due to their brain activity and neurotransmitter levels during withdrawal, it is an inevitable experience.
- Itching: One of the most common symptoms associated with Remeron withdrawal is that of itchiness. Many people report feeling very itchy and cannot contain the sensations to scratch their skin. This itchiness may be uncomfortable and persist for some time, but it will eventually go away as your nervous system adapts.
- Mania: During withdrawal from Remeron, individuals with bipolar disorder have been reported to experiencing a manic switch. In other words, if you have bipolar disorder, the withdrawal could make you transition to a state of mania. Although this will not occur in everyone with bipolar disorder, it is something to monitor during withdrawal.
- Mood swings: It is very common to experience changes in mood during withdrawal. Some days you may feel really depressed and angry, others you may feel hopeful and see the light at the end of the tunnel. Many people go through ups, downs, and changes in mood during the withdrawal process.
- Nausea: In some cases the nausea from withdrawal can become severe. If it becomes severe, the nausea can actually lead a person to vomit. To prevent severe nausea, make sure you follow a gradual tapering protocol. Some nausea upon discontinuation may be inevitable, but you will minimize it by slowly weaning.
- Panic attacks: During withdrawal from a potent drug that affects serotonin levels, it is possible to experience panic attacks. When you discontinue this medication, the levels of serotonin in your brain may be lower than average. This may lead you to feel increasingly anxious and make you prone to panic attacks. If you find yourself panicking, just know that these attacks will eventually go away as your neurotransmitters adjust.
- Racing thoughts: You may notice that your thoughts race when you initially come off of this medication. These racing thoughts are hypothesized to be what could potentially lead to mania or hypomania among susceptible individuals. In any regard, the racing thoughts can also be linked to anxiety, drops in serotonin, and heightened nervous system activity during withdrawal.
- Sleep changes: For many individuals, Remeron tends to improve their sleep. When coming off of the drug, you may notice that the quality of your sleep is reduced. You may have difficulty falling asleep, staying asleep, or getting an adequate amount of sleep each night. Your sleep patterns may fluctuate during withdrawal, but they will eventually stabilize.
- Suicidal thoughts: Many people who take this drug for depression may experience a resurgence of depression and suicidal thinking when they quit taking it. In some cases, the suicidal thoughts a person experiences during discontinuation could be significantly worse than prior to taking the drug. When withdrawing, your neurotransmission will often be imbalanced as a result of the drug you had been taking and discontinued. This imbalance is what can make people feel suicidal until their brain readjusts to normal functioning.
- Sweats: A very common withdrawal symptom from antidepressant medications is that of sweating. You may wake up during the middle of the night soaked in heavy night sweats and/or notice that you are sweating intensely throughout the day. This is one way your nervous system is readjusting itself and is part of the detoxification process.
- Tiredness: Although many people report heightened anxiety and difficulty sleeping when they withdraw from Remeron, others report feeling very tired. Additionally even individuals who have difficulty sleeping may notice lower than average energy levels throughout the day.
- Tremors: In various cases, people tend to notice that they are having “shakes” or tremors. This is a more common symptom in the acute stages of withdrawal. You will stop shaking once your body readjusts without the drug.
- Vomiting: Some individuals actually get pretty sick when they quit taking Remeron. If you quit cold turkey, your chances of vomiting increase because you have suddenly quit from a dose that your nervous system was used to getting. In order to decrease your chances of experiencing this symptom, take the time to gradually withdraw.
- Weight loss: Since most people tend to have increases in appetite and/or cravings for food when they are on this drug, they tend to gain weight. When the drug is stopped, most people have no difficulties losing the weight that they put on while taking the drug.
Remeron Withdrawal Duration: How long does it last?
Most people have reported withdrawal symptoms lasting a few weeks before the majority cleared up. However this doesn’t mean that everyone is going to feel back to their normal selves within one month of their last dose. How quickly you recover from withdrawal symptoms and adjust back to normal functioning will likely be influenced by individual circumstances including: your sensitivity to withdrawals, how quickly you tapered, and whether you are taking other drugs.
As a general rule of thumb that I recommend is to wait three full months (90 days) to reevaluate symptoms. Three months is a lengthy period of time and will give your body and brain some time to transition back to sober functioning. It may take some time before your nervous system and neurotransmitter levels revert back to how they were prior to your first dose of Remeron. Keep in mind that some people have reported experiencing symptoms over 6 months after their last pill – these are obviously the more extreme cases, but show how debilitating the withdrawals can be for some people.
After the acute symptoms have passed during the first couple weeks of withdrawal, take the time to make sure that you are engaging in healthy activities as this may help repair your nervous system. Getting some light exercise, eating healthy foods, staying productive, socializing, resting, and learning some relaxation techniques can go a long way towards speeding up recovery. What you are experiencing may be very uncomfortable and may push your mental limits, but maintain faith that you will eventually recover and you eventually will.
If you have successfully withdrawn from Remeron and/or are going through withdrawals, feel free to share your experience in the comments section below. Sharing your experience may really help another person who is dealing with the same thing.