Mirtaz
Mirtaz (Mirtazapine 7.5–45 mg) — tetracyclic NaSSA for MDD with insomnia, anxiety or weight loss. no sexual dysfunction, strong appetite stimulation.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer
Mirtaz (Mirtazapine 7.5 / 15 / 30 / 45 mg) is a tetracyclic antidepressant (NaSSA) for major depression, particularly when insomnia, anxiety, weight loss, or anorexia are dominant symptoms. Strongly sedating at low doses, less sedating at higher doses (counterintuitive — see below).
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What Mirtaz is and how it works
Mirtaz is a 7.5 / 15 / 30 / 45 mg mirtazapine tablet supplied by Sun Pharma. Mirtazapine is structurally and mechanistically distinct from SSRIs/SNRIs/TCAs. It is a noradrenergic and specific serotonergic antidepressant (NaSSA): it blocks central α2-adrenergic autoreceptors (raising NA and 5-HT release indirectly), 5-HT2A and 5-HT2C receptors (anxiolytic, sleep-promoting, no sexual dysfunction), and H1 histamine receptors (sedation and appetite stimulation).
At 7.5–15 mg, mirtazapine is most sedating. At 30 mg+, the noradrenergic component (which is more linearly dose-related than the H1 antihistaminergic component) starts to offset the H1 sedation. Many patients describe 30 mg as “feeling more energised” than 15 mg. If a patient wants more sleep, lower the dose — not raise it.
Indications and dosing
| Indication | Starting | Target | Max |
|---|---|---|---|
| Major depression | 15 mg HS | 30 mg HS | 45 mg |
| Depression with insomnia | 7.5–15 mg HS | 15 mg HS (often sufficient) | 30 mg |
| Depression with weight loss / anorexia | 15 mg HS | 30–45 mg HS | 45 mg |
| SSRI augmentation | 7.5–15 mg HS added to SSRI | 15 mg HS | 30 mg |
| Older adults | 7.5 mg HS | 15 mg HS | 30 mg |
Important safety considerations
Mirtazapine is one of the heaviest-weight-gain antidepressants — typical 4–7 kg over 6 months. Useful in patients with depression-related weight loss; problematic in obese or metabolic-syndrome patients. Check fasting lipids and HbA1c at 6 months.
Reversible neutropenia and rare agranulocytosis described — incidence approximately 1 in 1000. Stop immediately and check FBC if fever, sore throat, mouth ulcers, or other signs of infection appear in the first 8 weeks. Routine FBC is not required.
Mirtazapine commonly worsens restless legs syndrome and periodic limb movements of sleep — relevant in patients with prior RLS or sleep complaints.
All antidepressants carry an FDA black-box warning for increased suicidal ideation in patients under 25.
Common side effects
- Sedation: universal at 15 mg; lessens at 30+ mg; bedtime dosing harnesses it as benefit.
- Weight gain and increased appetite: 4–7 kg typical at 6 months.
- Dry mouth: common, mild.
- Constipation: mild anticholinergic action.
- No sexual dysfunction: distinct advantage over SSRIs.
- Vivid dreams: some patients describe unusually intense dreams.
- Cholesterol / triglycerides: small mean rise.
Drug interactions
- MAOIs — 14-day washout each direction.
- Strong CYP3A4 inhibitors / inducers — moderate effect on mirtazapine levels.
- CNS depressants (alcohol, benzodiazepines, opioids, Z-drugs) — additive sedation.
- Other serotonergic drugs — serotonin syndrome described but uncommon (mirtazapine’s 5-HT2A antagonism is partly protective).
- Warfarin — small INR rise; monitor.
Pregnancy, breastfeeding, paediatric
Pregnancy: limited data; weigh against untreated maternal depression. Breastfeeding: passes into milk; sometimes used in postpartum depression where insomnia and weight loss are concerns. Paediatric: not first-line.
Storage
Store at 15–30 °C in original packaging.
Frequently Asked Questions
Why is Mirtaz more sedating at 15 mg than at 30 mg?
Mirtazapine has dose-dependent effects on different receptors. At 15 mg, the H1 antihistamine action dominates — strongly sedating. At 30 mg+, the noradrenergic action ramps up and offsets the sedation. This is the opposite of intuition and is the most-asked question about mirtazapine. If your sleep is too heavy, raise the dose; if you want more sleep, lower it.
Will Mirtaz make me gain weight?
Yes — typically 4–7 kg over 6 months. This is one of the most reliable side effects. In patients with depression-driven weight loss it’s a feature; in obese patients it’s a problem. Discuss this trade-off explicitly before starting.
Why is Mirtaz taken at bedtime?
The H1 antihistamine sedation peaks 2–3 hours after the dose. Bedtime dosing recruits the sedation as a sleep benefit instead of daytime drowsiness. Morning dosing produces unacceptable drowsiness in most patients.
How is Mirtaz different from an SSRI?
Different mechanism (α2 + 5-HT2A/2C + H1 blockade vs SERT inhibition) translates to: more sedation, more appetite, more weight gain, no sexual dysfunction, less GI upset, less anxiety surge. Useful when those SSRI side effects are problematic or when insomnia/weight loss are dominant symptoms.
Can Mirtaz be combined with an SSRI?
Yes — the so-called “California rocket fuel” (SSRI/SNRI + mirtazapine) is a recognised combination for severe or partial-response depression. Mirtazapine is added typically at 7.5–15 mg HS. Specialist supervision recommended.
How long until Mirtaz works?
Sleep and appetite often improve within 1–2 weeks; the mood effect builds over 4–6 weeks at 15–30 mg.
How do I stop Mirtaz?
Taper over 2–4 weeks. Withdrawal is generally milder than SSRI/SNRI withdrawal but rebound insomnia and dysphoria are described.
Will Mirtaz affect my driving?
Yes — the first 1–2 weeks of sedation can impair reaction time. Avoid driving until you know your tolerability. After that, most patients drive normally on stable doses.
Does Mirtaz help anxiety?
Yes — the 5-HT2A and 5-HT2C antagonism contributes a meaningful anxiolytic effect, often visible within the first 1–2 weeks. Useful when depression and anxiety co-exist.
Is Mirtaz addictive?
No — no euphoria, no compulsive use, no escalating tolerance. Physical dependence is mild and shorter than SSRI dependence.
Other Mental Health Medications
- Agoprex (Agomelatine — melatonergic)
- Flunil (Fluoxetine SSRI)
- Duvanta (Duloxetine SNRI)
- Bupron XL (Bupropion XL — NDRI)
- Lexaheal (Escitalopram SSRI)
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| Strength | 7.5 mg |
|---|---|
| Quantity | 30 Tablet/s, 60 Tablet/s, 90 Tablet/s, 180 Tablet/s |
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