Mirtazapine vs Xanax: How are they different? 

In this article, we will compare the effects of two medications – Mirtazapine (Remeron) and Alprazolam (Xanax). We will discuss their FDA-approved clinical benefits, mechanisms of action, side effect profiles, and several other key differences.

What is the difference between Mirtazapine and Xanax?

Mirtazapine (Remeron) and Alprazolam (Xanax) are two different medications which work differently for the management of symptoms associated with mood disorders and insomnia. Let’s take a look at the basic clinical and therapeutic differences between these medications:

FDA-approved clinical uses

Mirtazapine is primarily approved by the FDA for the treatment of major depressive disorder (1,2). It’s an antidepressant that works by affecting the balance of certain chemicals in the brain to improve mood – which can be used off-label for anxiety (1,2). 

Xanax, on the other hand, is approved for the treatment of anxiety disorders, specifically generalized anxiety disorder and panic disorder (3,4). It belongs to a class of drugs known as benzodiazepines, which act on the central nervous system to provide calming effects and reduce anxiety (3,4).

However, both Mirtazapine and Xanax are used for the management of sleep disturbances, as they both are sedative in nature.

Mechanisms of action

Mirtazapine works by increasing the levels of two excitatory neurotransmitters – norepinephrine and serotonin in the brain. This helps improve mood and reduces symptoms of depression. It also has antihistamine properties, which contribute to its sedative effect, making it useful for sleep disturbances (2).

Xanax, as a benzodiazepine, enhances the effects of a neurotransmitter called gamma-aminobutyric acid (GABA). GABA has a calming effect on the brain, which helps reduce anxiety and promotes relaxation (4).

Side effect profiles

Mirtazapine may cause side effects like drowsiness, weight gain, increased appetite, dry mouth, nightmares, and constipation (1,2). 

It’s important to note that Mirtazapine can have fewer sexual side effects compared to some other antidepressants, which makes it a better option for people experiencing antidepressant-induced sexual issues.

Xanax, on the other hand, causes side effects like drowsiness, dizziness, and reduced coordination (3,4). Both medications can interact with other drugs, so it’s essential to inform your healthcare provider about all the medications you’re taking.

Addiction potential

Mirtazapine doesn’t have a significant potential for addiction (2). It’s considered suitable for long-term use, especially for treating depression. It doesn’t create the same craving or dependency that some other medications might. 

People can generally take Mirtazapine as prescribed by their doctor without worrying about developing addictive tendencies.

Xanax, on the other hand, is a benzodiazepine, and that puts it in a different category. Benzodiazepines, including Xanax, can have a higher risk of addiction, especially with prolonged or excessive use (3,4). 

They can create a feeling of dependence, where you might feel like you need to take more to achieve the same calming effect. This is why Xanax is often prescribed for short-term use to avoid the development of dependency.

Withdrawal symptoms

Withdrawal symptoms can be an issue with both medications, but they’re more pronounced with Xanax due to its potential for addiction – as it is a Schedule IV drug (3). 

If someone takes Xanax regularly and then suddenly stops, they might experience withdrawal symptoms like rebound anxiety, insomnia, restlessness, and even more severe symptoms like seizures in some cases (5).

With Mirtazapine, withdrawal symptoms are generally milder as compared to Xanax. However, if someone discontinues Mirtazapine abruptly, they might experience some discomfort, such as flu-like symptoms, mood changes, and rebound sleep problems (6). 

For successful Mirtazapine withdrawal, a proper taper schedule is necessary. The same is the case with Xanax, as these medications should never be stopped abruptly. It’s essential to work closely with your doctor when stopping any medication to minimize withdrawal effects.

How to choose between Mirtazapine and Xanax?

The decision between Mirtazapine and Xanax should always be made in consultation with your doctor. You should never start taking any medication without having a proper diagnosis and prescription. 

The right choice of medication can depend on several factors, as both of these meds can affect people differently. 

The nature of your symptoms is a significant factor before choosing between Mirtazapine and Xanax. If you’re dealing with depression, Mirtazapine is a logical choice since it’s specifically designed to treat major depressive disorder (MDD) (1). 

On the other hand, Xanax is primarily prescribed for anxiety disorders, so it might be the better option if anxiety is your primary concern (3). 

The severity of your symptoms also matters. For individuals with severe anxiety or panic symptoms, short-term use of Xanax might provide immediate relief (3). 

However, it’s crucial to recognize that Xanax isn’t suitable for long-term use due to its risk of dependency and withdrawal (5). For long-term management of ongoing symptoms, Mirtazapine might be the more appropriate choice.

It is worth mentioning that there are plenty of alternatives to both Mirtazazpine and Xanax, and your doctor may put you on a different medication for managing your symptoms in a safe and effective manner. 

Just make sure you stuck to your doctor’s prescribed regimen and do not make any changes to your treatment on your own. 


In this article, we have discussed the basic differences between Mirtazapine and Xanax. We have also talked about the factors which are important when deciding between the two medications and how you should always stick to your doctor’s prescribed regimen.

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The  Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. REMERON® (mirtazapine) tablets, for oral use. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020415s029,%20021208s019lbl.pdf


Jilani TN, Gibbons JR, Faizy RM, Saadabadi A. Mirtazapine. 2022 Sep 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30085601. https://pubmed.ncbi.nlm.nih.gov/30085601/


The  Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. XANAX (alprazolam) tablets, for oral use, CIV. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf


George TT, Tripp J. Alprazolam. 2023 Apr 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30844192. https://www.ncbi.nlm.nih.gov/books/NBK538165


Ait-Daoud N, Hamby AS, Sharma S, Blevins D. A Review of Alprazolam Use, Misuse, and Withdrawal. J Addict Med. 2018 Jan/Feb;12(1):4-10. doi: 10.1097/ADM.0000000000000350. PMID: 28777203; PMCID: PMC5846112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/


Spitznogle B, Gerfin F. Pruritus associated with abrupt mirtazapine discontinuation: Single case report. Ment Health Clin. 2019 Nov 27;9(6):401-403. doi: 10.9740/mhc.2019.11.401. PMID: 31824812; PMCID: PMC6881111. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881111/

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