What are the alternatives to Mirtazapine? (3+ options)

In this article, we will discuss the alternatives to Mirtazapine for the management and treatment of depression symptoms. We will also discuss how to choose the best antidepressant for you.

What are the alternatives to Mirtazapine? 

There are plenty of alternatives to Mirtazapine, some of which include:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Trazodone
  • Bupropion 

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that work differently than Mirtazapine (1). They primarily target the serotonin neurotransmitter in the brain to improve mood. 

Unlike Mirtazapine, which has a sedative effect and can help with insomnia, SSRIs can sometimes initially cause sleep disturbances like insomnia (2). However, this side effect often improves with time as your body adjusts to the medication.

SSRIs, like Zoloft, Lexapro, etc usually take about 4 to 6 weeks to start showing their full therapeutic effects (1). During this period, it’s essential to be patient and continue taking the medication as prescribed by your doctor. 

If insomnia persists while you wait for the SSRI to take effect, your healthcare provider may consider adding another medication or suggesting strategies to manage sleep issues.

The choice between Mirtazapine and SSRIs depends on various factors, including your specific symptoms, medical history, and how your body responds to each medication. Your doctor will carefully recommend the most suitable option to help you manage depression effectively.

Some common SSRIs include:

  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another class of antidepressants that can be considered as alternatives to Mirtazapine (3). They work by increasing the levels of both serotonin and norepinephrine in the brain, which can help improve mood and alleviate depressive symptoms.

Like SSRIs, SNRIs also typically take about 4 to 6 weeks to start showing their full therapeutic effects (3). It’s important to note that, similar to SSRIs, some SNRIs may initially cause sleep disturbances, including insomnia, in some individuals. 

However, this side effect often improves with time as your body becomes accustomed to the medication. On the other hand, some people may experience drowsiness when taking SNRIs, which can be an advantage for those who have trouble sleeping.

Managing these side effects and finding the right antidepressant often involves working closely with your healthcare provider. If insomnia persists with SNRI treatment, your doctor may suggest strategies or even add-on medications to help you manage sleep difficulties while waiting for the SNRI to take full effect.

Common SNRIs include:

  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)


Trazodone is another medication that can be considered as an alternative to Mirtazapine (4). Both Trazodone and Mirtazapine share the characteristic of causing sedation, which can make them effective options for managing insomnia (4). 

It’s common for some people to switch from Mirtazapine to Trazodone because of similar therapeutic benefits. This sedative effect is why they are sometimes used off-label to help people sleep. 

One advantage of Trazodone is that it can be used in combination with other antidepressants, like Prozac, Lexapro, Effexor, etc. This can be especially beneficial for individuals who require a more robust antidepressant effect. 


Bupropion is another antidepressant that can be considered as an alternative to Mirtazapine. Unlike Mirtazapine, Bupropion is known for its stimulating effects and is often considered one of the best antidepressants for increasing energy and motivation (5).

However, it’s essential to note that Bupropion can cause insomnia in some individuals due to its stimulating properties (5). If you find that Bupropion is interfering with your sleep, there are a couple of strategies you can consider.

One option is to take it in the morning instead of later in the day, as this may reduce its impact on nighttime sleep. Alternatively, you can discuss the issue with your doctor. 

They may be able to adjust the timing of your medication or explore other options to help manage any sleep disturbances while still benefiting from Bupropion’s antidepressant effects.

How to choose the best antidepressant?

Selecting the right antidepressant is a decision that should be made with the help of your healthcare provider. Your doctor knows your medical history and understands your specific symptoms. 

There isn’t a single “best” antidepressant that suits everyone because each person’s response to these medications can vary. It’s common for doctors to consider how your body tolerates a particular antidepressant when making their recommendation. 

What works well for one person may not be as effective for another. For instance, Zoloft might be the right choice for some, while Cymbalta could be more suitable for others.

It’s important to know that finding the most suitable antidepressant can sometimes involve a bit of trial and error. Switching between different antidepressants is not unusual, as your doctor aims to find the one that works best for you and helps alleviate your symptoms.

Just make sure you follow your doctor’s directions and avoid taking any medication on your own. 


In this article, we have discussed some alternatives to Mirtazapine, if it doesn’t help your symptoms for some reason. We have also talked about the process of selecting the right antidepressant and how you should always follow your doctor’s advice.

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Wichniak A, Wierzbicka A, Walęcka M, Jernajczyk W. Effects of Antidepressants on Sleep. Curr Psychiatry Rep. 2017 Aug 9;19(9):63. doi: 10.1007/s11920-017-0816-4. PMID: 28791566; PMCID: PMC5548844. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548844/


Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci. 2014 Mar;11(3-4):37-42. PMID: 24800132; PMCID: PMC4008300. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008300/


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