Remeron for Sleep and Depression in Oregon and Washington

What It Is

Remeron (mirtazapine) is an atypical antidepressant, FDA approved for major depressive disorder. In practice, it's prescribed off-label for insomnia way more often than it's used for depression these days. Not a controlled substance, not addictive, but extremely sedating.

Comes in tablets, regular and orally disintegrating. Doses range from 7.5mg to 45mg. For sleep, people usually take 7.5mg to 15mg. For depression, usually 15mg to 45mg.

What It Does

At low doses (7.5mg-15mg), Remeron is primarily a knockout sleep aid. It hits your histamine receptors hard, which causes significant sedation. You'll be asleep within 30 minutes and you'll sleep hard.

At higher doses (30mg-45mg), it works as an antidepressant by affecting serotonin and norepinephrine systems in your brain. The sedating effect is still there but less pronounced at higher doses (counterintuitive but that's how it works).

Also increases appetite significantly at any dose. This can be a feature or a bug depending on whether you need to gain weight or definitely don't need to gain weight.

How It Works

Mirtazapine blocks certain histamine receptors (H1) which causes sedation. That's the main mechanism for the sleep effect. It's why it works so fast and so reliably for knocking you out.

For the antidepressant effects, it's more complicated. It antagonizes certain serotonin and adrenergic receptors while enhancing activity at others. The net result is increased serotonin and norepinephrine activity in specific pathways that affect mood.

The appetite increase comes from blocking histamine and serotonin receptors involved in satiety. Your body stops getting the "I'm full" signal as strongly, so you eat more.

What It Feels Like When It's Working

For sleep: you take it, within 30 minutes you feel incredibly drowsy and heavy. Your eyelids weigh about 50 pounds each. You lie down and you're out. Most people sleep deeply and wake up feeling rested, though some wake up groggy.

For depression (at higher doses): takes weeks to show antidepressant effects, like other antidepressants. The sedation happens immediately but the mood improvement takes 4-6 weeks. You'll notice improved sleep and appetite first, then gradually improved mood and energy.

The appetite thing is immediate and it's strong. You'll be hungry. You'll want to eat everything. Snacks will call to you from the kitchen. Weight gain is extremely common.

Common Side Effects

Sedation is the most prominent side effect and also the main reason it's prescribed for sleep. At low doses this is desired. At higher doses for depression, daytime sedation can be a problem.

Increased appetite and weight gain are almost universal. Some people gain significant weight on Remeron. If you're underweight from depression this can be good. If you're already overweight or trying not to gain weight, this is a major problem.

Dry mouth is very common.

Constipation happens frequently.

Dizziness, especially when standing up quickly.

Some people feel foggy or cognitively slower on Remeron, particularly at higher doses.

Cholesterol and triglyceride levels can increase with Remeron use.

Rarely, Remeron can cause a serious condition called agranulocytosis where your white blood cell count drops. Signs include fever, sore throat, mouth sores. If you develop these symptoms, contact your provider immediately. This is rare but serious.

What It Looks Like When It's Not Working

For sleep: you're taking it and you're still not sleeping, or you sleep but wake up feeling like you got hit by a truck.

For depression: you've been on a therapeutic dose for 6-8 weeks and you're still depressed, or the side effects are so rough that any benefit isn't worth it.

Sometimes the dose needs adjustment. For sleep, sometimes 7.5mg isn't enough and you need 15mg. For depression, sometimes you need to go higher than 30mg.

Sometimes Remeron just isn't the right medication. The weight gain and sedation can be dealbreakers even if it's helping with sleep or mood.

Timeline for Noticing Effects

For sleep: immediate. First night, you'll feel the sedation within 30 minutes. If you don't, the dose is probably too low.

For antidepressant effects: 4-6 weeks at therapeutic dose (usually 30-45mg for depression). The timeline is similar to other antidepressants. Sleep and appetite improve first, mood improves later.

Real Talk About Remeron in Oregon and Washington

Remeron is prescribed constantly for insomnia because it's not a controlled substance, not addictive, and it works really well for knocking people out. It's a favorite of providers who are uncomfortable prescribing things like Ambien or benzodiazepines long-term.

The sedation is real and it's powerful. Low dose Remeron (7.5-15mg) will put you to sleep hard. Some people love this. Others find they're groggy the next day and can't wake up properly.

The weight gain thing is not a maybe, it's a when and how much. Plan on gaining weight if you take Remeron. For people who've lost weight from depression or who are underweight, this is actually beneficial. For everyone else, it's a major side effect that limits how long people are willing to stay on it.

Interesting thing about Remeron: lower doses are more sedating than higher doses. At 7.5mg, the sedation is maximal. At 30-45mg, there's less sedation because other receptor effects start balancing it out. This is opposite of how most medications work.

Our team sees this prescribed frequently throughout Oregon and Washington (Portland, Eugene, Salem, Vancouver, Spokane, Bellingham) for insomnia in people who either can't use or don't want to use controlled substances. It's also used when someone has both depression and insomnia and you want to kill two birds with one stone.

Generic mirtazapine is cheap and works fine. Brand name Remeron isn't covered by most insurance and isn't necessary.

If you're taking Remeron for sleep, you're essentially using a side effect of an antidepressant rather than taking the antidepressant for its intended purpose. This works fine but it's worth understanding that's what you're doing.

Don't drive or operate machinery until you know how Remeron affects you the next day. The sedation can persist into the morning, especially when you first start or if you're on a higher dose.

Mixing Remeron with alcohol increases sedation significantly. Both depress your central nervous system and the combination can be dangerous.

If you've been taking Remeron nightly for months and you're still having insomnia problems, the insomnia isn't the only issue. Something else needs to be addressed (anxiety, depression, sleep apnea, chronic pain, whatever).

Sleep and Depression Treatment Throughout Oregon and Washington

LiveWell Psychiatry and Men's Health provides treatment for insomnia and depression throughout Oregon and Washington, including Portland metro, Vancouver and Clark County, Salem, Eugene, Corvallis, Bend, Spokane, Tri-Cities, and surrounding communities. If you're dealing with sleep problems, depression, or both, we can evaluate whether Remeron or another approach is right for your situation.

Remeron is effective for what it does. Knocks you out reliably, can help with depression at higher doses, increases appetite. Those effects can all be positive depending on your situation. But the side effects (particularly weight gain and next-day sedation) limit who it works well for long-term. Still, for the right person in the right situation, it's a useful tool.