6 Potential Alternatives To Mirtazapine

Discover potential alternatives to Mirtazapine for depression, anxiety and insomnia. Which is the most similar drug to Mirtazapine?

Alternatives To Mirtazapine

Mirtazapine is one of the most common antidepressants sold in the world. In the US, it's most commonly known under the brand name 'Remeron'. It has a complex and unique mechanism of action, both indirectly stimulating serotonergic receptors while directly blocking others. 

As opposed to specific serotonin reuptake inhibitors (SSRIs), Mirtazapine's unique effect on serotonin receptors helps it decrease nausea, anxiety, and diarrhea while also being one of the few antidepressants without sexual side effects. 

In addition, Mirtazapine strongly affects H1 histamine receptors, this antihistaminic effect is the main cause for the drug's strong sedating effect and increased appetite. 

Having To Find An Alternative 

Every effect from Mirtazapine might not always be sought after, depending on the indication and person taking the drug. The strong sedation from Mirtazapine can be intolerable for individuals dealing with depression and already having difficulties waking up in the morning or feeling constantly tired. Others suffer from detrimental weight gain while taking the medication. 

Whatever the reason may be, it'd be optimal to find the best alternative to Mirtazapine when changing treatment. Ultimately, it's a decision between the patient and the prescribing physician. However, some alternatives may be more suitable than others, and being aware of the potential options can be beneficial.

The Different Indications

The main indications for which Mirtazapine is used are depression, anxiety disorders, and insomnia. It is only FDA-approved for major depressive disorder.

Depressed patients are frequently suffering from coexisting sleeping problems and depression-related anxiety, and thus may benefit from Mirtazapine's on-label use. Nonetheless, the drug is also prescribed off-label for isolated insomnia and certain anxiety disorders.

As such, the best alternatives to Mirtazapine depend on the indication that the patient is taking it for. Drug choices must be tailored to the needs of the patient, which is why proper communication between the healthcare provider and the patient is key to finding the best possible treatment. 

Depression alternatives

Escitalopram

Escitalopram, marketed under the name Lexapro, is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and generalized anxiety disorder. Common side effects include nausea and increased bowel movements, headache, and sleep disturbances. 

Unlike Mirtazapine, which can cause sedation and weight gain, Escitalopram is less likely to cause weight gain but may have sexual side effects, including reduced libido or difficulty achieving orgasm. It's a common first-line treatment for depression due to its efficacy and tolerability.

Fluoxetine

Sold under the name Prozac, this drug is another SSRI that primarily used to alleviate symptoms of depression, anxiety disorders, OCD, and certain eating disorders like binge eating disorder. It is often considered a first-line treatment due to its effectiveness and relatively tolerable side effect profile.

Fluoxetine differs quite a bit from Mirtazapine in terms of side effects as it can cause sexual side effects, decrease appetite, and lead to activation and alertness, as opposed to Mirtazapine causing sedation, making you feel sleepy. Fluoxetine can cause sexual dysfunction.

Anxiety alternatives

Sertraline

Sertraline, commonly known by its brand name Zoloft, is another SSRI that treats major depressive disorder, obsessive-compulsive disorder, panic disorder, and social anxiety disorder. The side effects profile of Sertraline can include gastrointestinal disturbances, insomnia, sexual dysfunction, and increased sweating.

It can increase energy levels and is less likely to cause sedation compared to Mirtazapine. It is well-regarded for its safety profile, especially in long-term use, and is a popular choice for treating both depression and anxiety. However, it can frequently cause sexual side effects, something Mirtazapine has not been shown to do.

Duloxetine

Duloxetine, most commonly known as Cymbalta, belongs to the class of serotonin-norepinephrine reuptake inhibitors (SNRIs). Duloxetine may be especially suitable for patients experiencing somatic or chronic pain in addition to anxiety and depression symptoms, as it has been found to reduce chronic pain.

Common side effects include nausea, dry mouth, and fatigue. Sexual side effects are generally not a prominent concern when taking Duloxetine, much like Mirtazapine. However, Duloxetine is not known to be prominently sedative.

Insomnia alternatives

Trazodone
Trazodone, just like Mirtazapine, has a unique mechanism of action. While primarily inhibiting serotonin reuptake, it also antagonizes certain serotonin receptors. 

Its most common side effects include drowsiness, dizziness, and a stuffy nose. Trazodone is frequently used in low dosages to treat sleeping difficulties. Sexual side effects are rare with Trazodone, just like with Mirtazapine.

Amitriptyline

An older generation antidepressant belonging to the group of medications known as Tricyclic Antidepressants. While still occasionally used in psychiatric care for treatment-resistant depression and insomnia, Amitriptyline is now more commonly prescribed for migraines and nerve pain.

Amitriptyline may frequently cause uncomfortable and significant side effects, due to which its use as an antidepressant has declined. Because of its sedating properties, it is occasionally prescribed in low dosages as a treatment for insomnia.

The Most Similar Drug To Mirtazapine

The most similar drug to Mirtazapine is most likely Trazodone. Despite their different mechanisms of action, they are both classified as atypical antidepressants and used for treating depression, anxiety, and insomnia. 

Although an effective alternative, Trazodone is not a very popular treatment option for major depressive disorder. This is due to its sedative side effect, but unlike Mirtazapine, Trazodone needs to be taken two to three times a day to produce its antidepressant effect.

Taking Trazodone in the morning frequently causes the patients to become very tired and unproductive for the rest of the day, typically not a wanted feature in depressed patients. 

Cover image by Freepik

Author: J. Martin, M.D.
Last update: July 30, 2024

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.