Since 2008, antidepressant prescriptions issued have increased by 8.5% per annum, and mirtazapine is a common treatment choice of doctors.
When we first start to take a new medication, we might need to think about how it will affect our lifestyle choices and habits.
While the NHS states that you can eat and drink as normal when taking mirtazapine, there are several things to be mindful of consuming while taking this antidepressant.
What is mirtazapine?
Mirtazapine is an antidepressant used to treat several mental health conditions, including:
- Major depressive disorder
- Panic attacks
- Anxiety disorders
- Depressive psychosis
Mirtazapine is available under several brand names, including Remeron or Remeron Soltab. As well as being available via prescription in the UK, it is also FDA-approved for use in the United States and is authorised for use in the EU.
Mirtazapine is a selective serotonin reuptake inhibitor that increases the amounts of norepinephrine and serotonin - mood-enhancing chemicals - in our brains.
What are the side effects of mirtazapine?
Mirtazapine has several side effects, most of which are common.
Sleepiness is one of the main side effects of mirtazapine, so many healthcare providers recommend taking it at the end of the day. Sleepiness is a common side effect among many antidepressants, including amitriptyline and escitalopram.
Other common side effects of mirtazapine include drowsiness, constipation, feeling sick, and mild headaches. Some people also experience dry mouth, weight gain and an increase in appetite.
There are a few more severe side effects of mirtazapine, but these are very rare.
For some patients, mirtazapine can cause suicidal thoughts, a side effect mainly associated with young adults who take the drug. However, caregivers can keep a close eye on their family member if they take mirtazapine to spot any changes in behaviour or suicidal thoughts.
Another more severe side effect of mirtazapine is hives or trouble breathing, and some people will experience an allergic reaction. Mouth sores, irritation, and sore throats can also be experienced by those who take this medication.
Some patients suffer from serotonin syndrome, a rare form of mirtazapine poisoning. Your GP should be able to offer full advice over the phone about the effects of mirtazapine on the body, and they can discuss any complications or suspected overdoses.
A healthcare provider can also reduce the dosage of a medication if it does not suit a patient. For example, if someone is coming off mirtazapine, their doctor may gradually reduce the dosage to avoid withdrawal symptoms and reduce the risk of depressive symptoms returning.
There are several ways you can reduce the risk of experiencing any of the possible side effects, too.
Herbs to avoid
Many people take herbal remedies and supplements daily. However, there is little to no research on the medical effect of herbal remedies - and some of them can negatively interact with common medicines such as mirtazapine.
For example, St. John’s Wort is a common herbal remedy widely used to treat mild or moderate depression. However, you should avoid taking St. John’s Wort when taking mirtazapine, as it can increase serotonin levels in the blood. Although the brain needs serotonin to combat low mood and depression, too much of this chemical can lead to serotonin syndrome.
Taking St. John’s Wort and mirtazapine together can also lead to an increase in heart rate and blood pressure and a worsening of other side effects.
Mirtazapine and alcohol
One of the main things to avoid when taking mirtazapine is alcohol.
As a depressant, alcohol affects the brain and can worsen the side effects of taking an antidepressant. In addition, combining alcohol and mirtazapine can cause dizziness, drowsiness and difficulty concentrating.
Many of us feel sleepy after a glass of wine even when we're not on medication, and consuming alcohol while taking mirtazapine will exacerbate its side effects.
Drinking alcohol daily or in large amounts can worsen symptoms for many patients taking this drug. It also makes it harder for mirtazapine to work correctly; none of us feels ourselves after a day of drinking anyway!
Many healthcare providers suggest it is best to stop drinking alcohol for the first few days of treatment to understand how mirtazapine will affect your concentration, decision-making skills and cognitive function.
Limiting alcohol while taking mirtazapine can also lead to better judgement and a clearer sense of mental awareness.
Recreational drugs such as cannabis can cause similar issues when used simultaneously with mirtazapine. In addition, these substances can lead to sleepiness and a lack of mental clarity, especially when taking an antidepressant such as mirtazapine.
How does mirtazapine interact with other medications?
There are a few medications that you should not take with mirtazapine.
Antidepressants called monoamine-oxidase inhibitors (MAOIs) can cause dangerous interactions with other antidepressants if taken in close succession.
These types of antidepressants include drugs such as tranylcypromine, phenelzine, linezolid and isocarboxazid. These interactions are so important that you should tell your doctor if you have ever taken any MAOIs, even if you're not taking them right now.
Strong medication such as tramadol, diazepam and morphine can also affect mirtazapine, and these drugs can exacerbate the side effects of this antidepressant.
Warfarin and other anticoagulants can interact with mirtazapine and certain epilepsy medicines, including carbamazepine and phenytoin.
Many drug interactions with mirtazapine come from the excess serotonin they can create in our brains. For example, lithium affects our serotonin level, which can lead to serotonin syndrome when taken alongside mirtazapine.
Who can’t take mirtazapine?
Some people cannot take mirtazapine. If you have any of the below medical conditions, your doctor will likely prescribe you a different medication.
- Low blood pressure
- High cholesterol or triglycerides, because mirtazapine can increase cholesterol levels
- Are a new mother currently breastfeeding or are pregnant
- Glaucoma or similar eye conditions because mirtazapine can increase pressure in the eye
- Epilepsy, as mirtazapine can increase the risk of a seizure
You might still be able to take mirtazapine with these pre-existing health conditions, but your doctor will make the call.
For example, people with pre-existing hyperlipidemia are often monitored by a healthcare provider while taking this antidepressant, so any changes can be made as soon as possible if necessary.
Likewise, if you’re experiencing other mental illnesses you should tell your doctor and understand how an antidepressant will affect your mood and existing mental health concerns. For example, mirtazapine can adversely affect those with bipolar disorder and manic depression.
Understanding what to avoid when taking mirtazapine
It can be daunting to start taking a new medication, and it can be hard to access accurate and precise information about what to avoid while taking new prescriptions.
There is nothing wrong with taking an antidepressant. Although there are a few critical, serious side effects to look out for when taking mirtazapine, these are rare.
For the most part, this medication is unaffected by our lifestyle choices. However, there are a few key ways to stay on top of potential side effects. As we've seen, avoiding specific herbal remedies and alcoholic drinks can make this medication easier to handle.
Talking to a doctor is the best way to find up to date drug information that works for your individual needs. If you need urgent advice about any side effects while taking this antidepressant, call 111 or 999 in an emergency.