Remeron (Mirtazapine) — Anything Safer for Sleep & Depression?

I have read some very positive things about Remeron (Mirtazapine), and a few startling posts as well. Are there any safer prescription alternatives to Remeron?

Currently I am using Ativan and Ambien to fall asleep, but only get a few hours (usually wake at 2-3 am with tinnitus and anxiety).

I have tried all the normal OTC options (last night was Valerian + Melatonin + Tryptophan) and got about 2 - 2.5 hours before being awakened.

I won't be able to keep working if I don't get some sleep.

I don't know if I have any issue with ototoxicity in general. I have had tinnitus for a while, but got some ear pressure a few weeks ago followed by a bad tinnitus spike for the last week. I am having a terrible time coping. I don't want to take anything that may contribute to it (if it is ototoxicity) but I really can't function with this level of anxiety, stress and depression. My hearing tests were normal (up to 8 kHz) but think I have some high frequency loss (just from the on line stuff).

Following up with all the pertinent professionals.

Thanks in advance!

Mark

 

If you do go with Remeron, keep in mind that you need only a very low dose for sleep. I need only 5mg(1/6th of a full tablet) and I have a good and full night's sleep with only the occasional hangover the next day. I've been taking 5mg of remeron a night for almost 2 years now and I haven't noticed any long-term side-effects. Of course, that's just me, it may or may not work the same for you so tread with caution.

 

With Remeron, the less the dosage, the better it works for sleep issues.

 

Yeah, I took 2 mg of Remeron, and it knocked me out.

 

I used Ativan and Ambien for many years on and off. It worked well for me and did not affect my tinnitus. When at my lowest point, I popped 3-4 1/2 tablets to get me through the night. Once I got my stress under control, it was not too big of a deal to slowly taper.

I tried Remeron as well but it did not work out. Too much of a hangover feeling.

 

I take 3.75 mg of Mirtazapine every night and it works as well as 30 mg which was my starter dose.

If you have access to a very knowledgeable psychiatrist or a very understanding PCP, you could ask them to prescribe either Daridorexant or Lemborexant, depending if you live in the EU or USA/Japan.

 

I use Ambien (Zolpidem) to get back to sleep when I wake up in the middle of the night. I use about 1/6 to 1/8 of a 10 mg tablet.

I use Ativan (Lorazepam) at 0.5 mg in the morning occasionally to reduce morning anxiety. I average about once every third day to minimize the tolerance and dependency of the benzo, plus it also has some cross tolerance with Ambien.

I haven't tried Remeron (Mirtazapine). I mentioned it to my doctor, but he wasn't quick to wanting to prescribe it.

Those are higher tier non-preferred non-generic drugs through my insurance. I think my doctor would prescribe it, and I would like to try it, but insurance won't cover much of the cost if they consider a lower cost drug to be suitable. Plus, I would have to hit the plan deductible before they covered it. Dayvigo (Lemborexant) is over $300/mo, and Quviviq (Daridorexant) is about $500/mo.

 

In my opinion, Mirtazapine is a good sleep aid even at very low doses (3.75 mg). However, it has one common side effect: weight gain. In my opinion, it is therefore unsuitable for people with a BMI of over 28.

 

Mirtazapine is why I'm here.

If you develop tolerance to it or if it gives you an adverse reaction, like taking away your sleep, visual snow syndrome, headaches, tremors, muscle twitching, nausea, etc., expect the withdrawal and the healing process to last a LONG time. And you'd be dealing with all kinds of horrible tinnitus sounds.

I have all these symptoms. Luckily my tinnitus is better, but is still there. The TTTS I got from Mirtazapine is horrible.

The problem with Mirtazapine is that it hits TOO MANY receptors (if I'm not mistaken, could be as high as 50 but don't quote me on that), so, withdrawing from it is HARDER than most other drugs out there.

It's very hard to be me these days...

 

I'm currently trying to get off of Mirtazapine myself. I have been taking less than 2 mg for several weeks now, and just stopped taking it completely 3 days ago. I've been able to sleep the same so far, and no adverse reactions that I know of yet. This is my 3rd attempt to get off this stuff. The first 2 times it was just too hard. I am hoping that coming off of it, I might see some improvement in tinnitus, but not holding my breath.

I gained 20 lbs after starting Mirtazapine, but I could sleep so I guess it was worth it.

 

Sorry to hear you're going through that. That makes the commonly mentioned weight gain side effect sound mild by comparison. How much of a dose were you taking each day and for how long?

I've read some similar posts from @TheDanishGirl about taking Mirtazapine (30 mg was needed for sleep) in the past:

• https://www.tinnitustalk.com/posts/688436
• https://www.tinnitustalk.com/posts/652543

 

How long were you on the Mirtazapine and at what dosage? How are you certain it was Mirtazapine and not antibiotics that negatively impacted you? No acoustic trauma or anything of that sort around the time you were using these medications? In your opinion, would an SSRI be more appropriate if you have to medicate for your mental health?

 

OK. I'm 100% sure Mirtazapine messed me up tinnitus wise, but antibiotics also. No acoustic trauma.

I had many types of tinnitus, it all started with ETD after antibiotics, this one was coming from my ears and I could suppress it if I turned any masking sound on, i.e. residual inhibition. This form of tinnitus has healed completely, along with ETD.

Since I could not sleep, I was taking Mirtazapine, but it wasn't working all the time; it would work for 3 consecutive days max, and it was SLOWLY taking away my sleep and fragmenting it. I thought it was the antibiotics doing it but no, so I had to rotate it with other stuff (Unisom) when it did not work. My dose was 7.5 mg, but I sometimes took 15 mg. This was a mistake. You can't go up and down, you can't take it as needed, you can't rotate it with anything. Once you are on it, you are supposed to take it daily, at the same dosage.

After the very first pill, I got hit by visual symptoms, but attributed them to the antibiotics. BIG MISTAKE.

After 42 days, I could sleep on my own, no meds. So I dropped the Mirtazapine completely. 18 days went by and my tinnitus got so much better that it would disappear on some nights completely!

That's when hell broke loose in my head, I got electric zaps unlike any one of you experienced, dysacusis, hyperacusis, noxacusis, daily multiple SBUTTs, and new tones...

Since this event got me scared so much, I got back on Mirtazapine. My tinnitus during this time turned reactive and went up and up. I got full blown visual snow syndrome and completely lost sleep.

I was about to end it, so my dad took me to a hospital. They ran tests on me to see I had no hearing loss...
NONE. Antibiotics did not damage my cochlear hair cells. I can hear up to 20 kHz. I attached my audiogram in a previous post.

I decided to drop all drugs. The SBUTTs were the first to diminish, along with reactivity and noxacusis, over time.
6 months after dropping it, the reactivity is ALMOST completely gone. Dysacusis and noxacusis are completely gone. SBUTTs still happen but not nearly as frequent or loud as before. They were so loud I couldn't understand speech at times. Hyperacusis is still there, but I can go out and it does not cause much problems. TTTS, on the other hand...

So yeah.

In my opinion, for mental health, I would suggests no pills at all. I got hurt by them immensely, how could I suggest anyone else to take them? I find them more harmful than hardcore street drugs. Recent studies also showed that they are no more effective than sugar pills, more information can be found over at survivingantidepressants.org.

If my account is not enough, you can go to patient.info or survivingantidepressants.org and run a search, tinnitus and Remeron/Mirtazapine, you will find hundreds of testimonies that this drug caused tinnitus and other symptoms.

People took their lives since withdrawal from this drug hit them so hard.

Oh, she's not the only one on Tinnitus Talk.

Read @MariaH's posts. @Wendy A and @Tweaker also got hit by Mirtazapine.

@Andrew01 got hit with visual snow syndrome. Here is his topic.

Before taking it, I got fooled by reading the positive posts here, especially by Dr. Stephen Nagler, making me think Mirtazapine wouldn't give me any bad symptoms... BIG MISTAKE. White coats are drug pushers and know nothing about the dangers of these drugs. This drug is VERY, VERY dangerous, and I can't believe some of you are still considering taking it.

XEN1101 is my only hope, hopefully, I could take it with no adverse reactions when it comes out! My tinnitus is quite low and electrical, not tonal, coming from the brain. The tones have all disappeared. Maybe it could cure me, based on what I have read on the Retigabine threads...

 

I'm taking Mirtazapine for sleep. I will ask about withdrawal next time when I see my psychiatrist.

 

I know. I mentioned her because it is the most serious account I have read on Mirtazapine.

With Mirtazapine, I would say it's usually because some people have terrible insomnia that continues and wears you down, usually or often combined with anxiety, and many people have reported it helping them with sleep at low dosage.

I've had terrible sleeping problems due to increased tinnitus intensity for almost two years and have been taking 1 to 2 mg Zolpidem (Ambien) almost every night at some point overnight and sometimes a second time. And I still only get about three or four hours some nights, probably average about 5 hours of broken sleep. I don't want to take larger doses of the 10 mg tablet because it will build more tolerance and dependency.

Those OTC meds you mentioned like Unisom, and also prescription Hydroxyzine 25 mg and Trazodone 50mg haven't been very effective for me (not even from the first dose), nor have Melatonin and quite a few supplements I've tried. Neither has THC nor CBD/CBN.

I also was on 50 mg Nortriptyline (TCA antidepressant) for a few months and 10 mg Lexapro (SSRI antidepressant) for seven weeks, and I experienced no improvement in sleep or anxiety. And two months after a two week weaning off of Lexapro, I still have stomach pains, which is the side effect I had while taking it, which is why I stopped taking it.

For anxiety, I have a prescription for 0.5 mg Lorazepam (Ativan), but due to all of the possible long-term side effects of benzos, I have been limiting myself to one pill every three days. And even when I take it, it's very mild in its effect. Taking it more often would just build tolerance and dependency and make it less effective while increasing my baseline anxiety.

Sleep and anxiety continue to be issues for me going on two years, so that's why I consider things like Mirtazapine. Everything has its risks. I would rather not have to take any medication for these issues, but it is unbearable at times. I'm considering Buspirone (BuSpar) now for anxiety, but it appears to only works for about half the people (or less) who take it.