What is the role of mirtazapine (Remeron) in the treatment of anxiety disorders?

Updated: Mar 27, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: David Bienenfeld, MD  more...
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Answer

Mirtazapine (Remeron) [55] has a much more sedating effect, generally reducing its potential to aggravate initial anxiety. Mirtazapine acts distinctly as an alpha-2 antagonist, consequently increasing synaptic norepinephrine and serotonin, while also blocking some postsynaptic serotonergic receptors that conceptually mediate excessive anxiety when stimulated with serotonin.

Mirtazapine may cause residual morning sedation that often improves with continued therapy and may cause an increase in appetite or weight gain. A study by Kim et al suggests among patients with major depressive disorder who have high anxiety symptoms, mirtazapine (15-30 mg/d) administered in the early weeks of treatment may have an earlier-onset action for anxiety symptoms. [56]


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