What to do if Mirtazapine does not work for sleep?

In this article, we will discuss what one should do if Mirtazapine does not provide adequate relief from symptoms associated with insomnia. We will also discuss alternative prescription medication to Mirtazapine that can be used if the antidepressant fails to work in your case. 

What to do if Mirtazapine does not work for sleep?

It’s best to reach out to your healthcare provider if Mirtazapine does not work for sleep. Your doctor may suggest dose escalation, but it is not possible in every case, especially not for people who solely take Mirtazapine as a sleep aid. 

Mirtazapine is a prescription medication which is primarily used for the management and symptoms of depression (1). However, it’s one of the very few antidepressants that cause sedation and can be used for insomnia at low doses. 

Although it is not approved by the Food and Drug Administration (FDA) for anything other than depression, taking Mirtazapine for insomnia is considered one of the common off-label uses of this medication (2). 

However, the sedative effects of Mirtazapine may start to wear off as your body adjusts to the medication, which makes it ineffective to use for insomnia. In such a case, it’s best to head out to your doctor and discuss other options that are safer and more effective for you to take for your sleep disturbances. 

How to take Mirtazapine properly to maximise its effectiveness for sleep disturbances?

The following points are important to maximise the benefits of Mirtazapine for sleep disturbances (1,3):

  • Take Mirtazapine as prescribed by your doctor, usually right before bedtime. This helps align its sleep-inducing effects with when you want to sleep, maximizing its impact on improving your sleep quality.
  • Avoid stimulating activities like using electronic gadgets, watching movies, or engaging in intense conversations after taking Mirtazapine.
  • Take Mirtazapine at the same time every night. Consistency helps your body get used to the medication’s effects, and it can help regulate your sleep pattern over time.
  • Reduce alcohol and caffeine intake, especially in the evening. These substances can interfere with the medication’s sleep benefits and disrupt your sleep cycle.
  • Keep your bedroom cool, dark, and quiet. Comfortable pillows and a supportive mattress can make a big difference in making you feel peaceful and relaxed.
  • Maintain a healthy lifestyle. Regular exercise, a balanced diet, and managing stress can all contribute to better sleep.

What are the alternatives to Mirtazapine for sleep problems?

There are plenty of over-the-counter (OTC) and prescription sleep aids which can be used instead of Mirtazapine. However, the right choice of medication depends on patient-specific factors. If you’re not depressed or anxious, you may not need to take an antidepressant as a sleep aid. 

There are other options that you can take to sleep peacefully at night. If OTC options don’t work for you, there are also prescription medications that your doctor may suggest in case Mirtazapine does not work. 

Just make sure you talk to your doctor about this and do not stop taking Mirtazapine or start taking any other medication on your own. 

OTC sleep aids include: (4)

  • Diphenhydramine
  • Doxylamine
  • Melatonin supplements
  • Ashwagandha 

Prescription sleep aids include: (5,6)

  • Benzodiazepines – Examples include Xanax (Alprazolam), Klonopin (Clonazepam), etc.
  • Non-benzodiazepine hypnotics – Examples include Ambien (Zolpidem), Lunesta (Eszopiclone), etc.
  • Melatonin receptor agonists – Examples include Rozerem (Ramelteon).
  • Other sedative antidepressants (Off-label use) – Trazodone.
  • Orexin receptor antagonists – Suvorexant

Remember, these are prescription medications and should never be taken without a doctor’s approval. 


In this article, we have discussed what one should do if Mirtazapine does not work for sleep. We have also discussed a few important points to maximise the effects of Mirtazapine for sleep and some alternative medications that can help you with sleep disturbances. 

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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


Centers for Disease Control and Prevention (CDC). Tips for Better Sleep [Internet]. Available from: https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html


Almond SM, Warren MJ, Shealy KM, Threatt TB, Ward ED. A Systematic Review of the Efficacy and Safety of Over-the-Counter Medications Used in Older People for the Treatment of Primary insomnia. Sr Care Pharm. 2021 Feb 1;36(2):83-92. doi: 10.4140/TCP.n.2021.83. PMID: 33509331. Available from: https://pubmed.ncbi.nlm.nih.gov/33509331/


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