Is it hard to get off mirtazapine?

October 6, 2025 •

3 min read

According to some reports, mirtazapine generates more withdrawal-related calls to medication helplines than many other antidepressants, highlighting the potential for difficulty. For some individuals, it is it hard to get off mirtazapine, a process that can lead to physical and psychological withdrawal symptoms.

Quick Summary

Discontinuing mirtazapine can be challenging due to discontinuation syndrome, a physiological response to the brain's adjustment to chemical changes. Proper medical guidance and a gradual tapering plan are essential to minimize discomfort and reduce the risk of relapse.

Key Points

Gradual Tapering is Essential: Never stop mirtazapine abruptly, as this significantly increases the risk of severe withdrawal symptoms.
Withdrawal Symptoms Vary: The intensity and duration of discontinuation syndrome are influenced by individual factors like dosage, duration of use, and metabolism.
Common Symptoms: Be prepared for potential physical symptoms like dizziness, nausea, and 'brain zaps', and psychological effects like anxiety and mood swings.
Professional Guidance is Critical: Work with a healthcare provider to create a personalized tapering schedule that minimizes withdrawal effects and ensures safety.
Supportive Strategies Help: Non-medication strategies such as therapy, stress reduction, and maintaining a healthy lifestyle can aid in managing withdrawal symptoms.

Mirtazapine, often known by the brand name Remeron, is an atypical antidepressant used to treat major depressive disorder. It is also prescribed off-label for conditions such as anxiety and insomnia due to its sedating effects. While effective for many, discontinuing mirtazapine can be challenging. Stopping abruptly can cause antidepressant discontinuation syndrome (ADS), a range of physical and psychological symptoms. This article explores the factors influencing the difficulty of getting off mirtazapine and safe strategies under medical supervision.

Understanding Mirtazapine Withdrawal

Antidepressant discontinuation syndrome (ADS) can occur when stopping or reducing antidepressant dosage, resulting from the brain adapting to the drug. Mirtazapine affects specific serotonin and histamine receptors, and noradrenergic neurotransmission. Withdrawal symptoms arise as the brain re-regulates these systems. It's a physical dependency, not addiction.

Common Mirtazapine Withdrawal Symptoms

Withdrawal symptoms vary in intensity and duration and can be physical and psychological. Common symptoms include:

Flu-like symptoms (chills, sweats, headaches)
Gastrointestinal issues (nausea, vomiting, diarrhea)
Sleep disturbances (insomnia, vivid dreams)
Sensory disturbances ("brain zaps," tingling)
Emotional changes (anxiety, irritability)
Dizziness
Changes in appetite
Rebound depression

Factors Influencing the Difficulty of Getting Off Mirtazapine

Several factors affect the difficulty of stopping mirtazapine:

Dosage: Higher doses (over 15 mg) can lead to more pronounced withdrawal.
Duration of Use: Longer use increases the risk of severe withdrawal.
Abrupt Cessation: Stopping suddenly is a strong predictor of severe symptoms.
Tapering Schedule: A slow, personalized plan minimizes withdrawal.
Individual Factors: Metabolism, genetics, and other conditions influence the process.

Comparison of Tapering vs. Abrupt Discontinuation


Feature	Gradual Tapering (Recommended)	Abrupt Discontinuation ("Cold Turkey")
Risk of Withdrawal	Significantly lower	Very high
Severity of Symptoms	Milder, more manageable	Can be severe and debilitating
Risk of Relapse	Lower	Higher
Timeframe	Weeks to months	Immediate, peaking within 1-2 weeks
Body Adjustment	Gradual adjustment	Sudden shock to the nervous system

The Safe Way to Taper Off Mirtazapine

Tapering off mirtazapine safely requires medical guidance. A personalized tapering schedule reduces the dose over time, allowing the body to adjust.

Consult Your Doctor: Discuss stopping with your healthcare provider to develop a plan.
Develop a Personalized Tapering Plan: Your doctor will create a schedule, often reducing the dose by 10-25% every 1-4 weeks. Hyperbolic tapering may be used for very low doses.
Use Available Formulations: Tablets and liquid formulations can help achieve precise dose reductions.
Monitor Your Symptoms: Track symptoms to help your doctor adjust the tapering speed.
Adjust the Pace as Needed: If withdrawal is severe, your doctor may recommend slowing the taper.

How to Manage Mirtazapine Withdrawal Symptoms

Supportive strategies can help manage withdrawal alongside tapering.

Prioritize Sleep: Maintain a consistent sleep schedule.
Reduce Stress: Practice meditation, yoga, or deep breathing.
Maintain Health: Focus on a healthy diet and hydration.
Seek Support: Talk to friends, family, or a therapist (CBT can be helpful).
Consider Remedies: Discuss over-the-counter options for specific symptoms with your doctor.

Conclusion

Getting off mirtazapine can be challenging, but it is manageable with the right approach. Avoid stopping abruptly and work closely with a healthcare provider on a personalized tapering schedule. Gradual reduction minimizes distress and relapse risk, allowing the body and brain to adjust. Combining professional guidance with self-care strategies can help individuals successfully discontinue mirtazapine. More information on medication tapering can be found on the Mayo Clinic website.

Frequently Asked Questions

Mirtazapine withdrawal, or antidepressant discontinuation syndrome, can cause symptoms such as dizziness, nausea, headaches, anxiety, irritability, insomnia, vivid dreams, and flu-like symptoms.

The duration of mirtazapine withdrawal varies widely. For most, symptoms begin within days and last a few weeks, but for some, particularly those who took the medication long-term, symptoms can be more prolonged.

Tapering is necessary because mirtazapine affects brain chemicals like serotonin and norepinephrine. A gradual reduction allows the brain to slowly adjust to these neurochemical changes, minimizing the risk and severity of withdrawal symptoms.

Cutting tablets to achieve smaller doses may be possible for some formulations, but should only be done with a doctor's explicit guidance. For very low doses, a doctor may recommend a liquid formulation for greater precision.

Withdrawal symptoms typically appear within days to weeks of stopping and include physical and psychological symptoms that resolve as the body adjusts. A relapse is the return of the original depressive symptoms, which typically occurs weeks to months after discontinuation.

Yes, sensory disturbances such as 'brain zaps' (electric shock-like sensations in the head) are a known withdrawal symptom associated with abrupt discontinuation of mirtazapine.

Alternatives to mirtazapine can include other classes of antidepressants like SSRIs (e.g., fluoxetine, sertraline), SNRIs (e.g., duloxetine), or atypical antidepressants like bupropion. Talking therapies like CBT are also highly effective.