What to do if Mirtazapine does not work for sleep?
By
Dr Natalia Marceli Stephanes (PhD)
Author bio
Dr Natália Marcéli Stephanes PhD is a Pharmacist with expertise in Drugs Administration and Toxicity; Discovery of New Drugs; Cancer Treatment; Biochemical Analyzes and Hematological Analyzes. She writes and reviews content on these topics.
Dr Natália Marcéli Stephanes’ Highlights:
- Pharmacist at the Department of Health of Santa Catarina State, Brazil
- PhD with a focus on oncology treatment
- Years of experience in commercial pharmacy
- Bachelor, Master and PhD degrees in Pharmacy at the Federal University of Santa Catarina
Professional Experience:
From her undergraduate studies to her Master’s and Doctorate degrees in Pharmacy, Dr Natália Marcéli Stephanes has participated in numerous scientific studies in the field of oncology and onco-hematology at the University Hospital of the Federal University of Santa Catarina, Brazil. Her research has focused on understanding the molecular and biochemical bases of malignant neoplasms and investigating safer and more effective therapeutic alternatives.
Dr Natália Marcéli Stephanes has also served as an assistant professor of haematology for undergraduate students at the Federal University of Santa Catarina. Additionally, she held the position of professor of Hospital Pharmacy at the Qualificar Technical School in Brazil, where she developed instructional materials for use in the Pharmacy Postgraduate Program at the Leonardo Da Vinci University Center.
In addition to her academic experiences, Dr Natália Marcéli Stephanes possesses a strong expertise in commercial pharmacy, with in-depth knowledge of medications, their routes of administration, desired effects, adverse effects, and toxicity.
Currently, Dr Natália Marcéli Stephanes works as a Pharmacist at the Health Department of Santa Catarina State, where her role entails providing pharmaceutical scientific consulting services to judges.
Education:
- 2016 Bachelor in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2018 Master in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2023 PhD in Pharmacy at the Federal University of Santa Catarina, Brazil
The main publications of Dr Natália Marcéli Stephanes are:
Falchetti M ; Delgobo M, Zancanaro H, Almeida K, Das Neves RN, Dos Santos B, Stefanes NM, et al. Bishop Omics-based identification of an NRF2-related auranofin resistance signature in cancer: Insights into drug repurposing. Comput. Biol. Med [Internet]. 2023; 152:106347.
Feuser PM, Matos dos Santos PC, Cordeiro AP, Stefanes NM, Walter LO, Maioral MF, Santos-Silva MC, et al. Antineoplastic activity of free 4-nitrochalcone and encapsulated in poly(thioether-ester) nanoparticles obtained by thiol-ene polymerization in two human leukemia cell lines (Jurkat and K562). J Drug Deliv Sci Technol [Internet]. 2022; 67:102924.
Jacques AV, Stefanes NM, Walter LO, Perondi DM, Efe FL, Souza LFS, Sens L, et al. Synthesis of chalcones derived from 1-naphthylacetophenone and evaluation of their cytotoxic and apoptotic effects in acute leukemia cell lines. Bioorg. Chem [Internet]. 2021; 116:105315.
Duarte BF, Vieira DSC, Lisboa ML, Stefanes NM, Grando LJ, Santos-Silva MC. Características clínico-epidemiológicas de pacientes portadores de carcinoma de células escamosas de boca. Arquivos Catarinenses de Medicina. 2021; 50(2): 232–245.
Machado V, Jacques AV, Stefanes NM, Santos-Silva MC, Biavatti MW. Anti-leukemic activity of semisynthetic derivatives of Lupeol. Nat. Prod. Res. 2021; 35(22):4494-4501.
Bigolin A, Maioral MF, Stefanes NM, Mascarello A, Chiaradia-Delatorre LD, Nunes RJ, Yunes RA, et al. A novel sulfonamide derivative as a strong and selective apoptotic agent against hematological malignancies. Chem. Pap. 2020; 74:2965–2976.
Bigolin A, Maioral MF, Stefanes NM, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Cytotoxic mechanisms of primin, a natural quinone isolated from Eugenia hiemalis, on hematological cancer cell lines. Anticancer Drugs. 2020; 31(7):709-717.
Maioral MF, Stefanes NM, Neufeldt PD, Chiaradia-Delatorre LD, Nunes RJ, Santos-Silva MC. Aldehyde biphenyl chalcones induce immunogenic apoptotic-like cell death and are promising new safe compounds against a wide range of hematologic cancers. Future Med. Chem. 2020; 12(8):673–688.
Perondi DM, Jacques AV, Stefanes NM, Maioral MF, Sens L, Pacheco LA, Cury NM, et al. A novel thiosemicarbazone as a promising effective and selective compound for acute leukemia. Anticancer Drugs. 2019; 30(8):p 828-837.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Argenta DF, Dotto MER, Santos-Silva MC, et al. PEO-chitosan nanofibers containing carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanoparticles loaded with pyrazoline for skin cancer treatment. Eur. Polym. J. 2019; 119:335-343.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Santos-Silva MC, Nunes RJ, Parize AL, et al. A new and efficient carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanocarrier for a pyrazoline with antileukemic activity. Mater. Sci. Eng. C [Internet]. 2019; 105:110051.
Maioral MF, Stefanes NM, Bigolin A, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Miconidine acetate, a new selective and cytotoxic compound with synergic potential, induces cell cycle arrest and apoptosis in leukemia cells. Invest. New Drugs. 2019; 37:912–922.
Srefanes NM, Toigo J, Maioral MF, Jacques AV, Chiaradia-Delatorre LD, Perondi DM, Ribeiro AAB, et al. Synthesis of novel pyrazoline derivatives and the evaluation of death mechanisms involved in their antileukemic activity. Bioorg. Med. Chem. 2019; 27(2):375-382.
Maioral MF, Bodack CN, Stefanes NM, Bigolin A, Mascarello A, Chiaradia-Delatorre LD, Yunes RA, et al. Cytotoxic effect of a novel naphthylchalcone against multiple cancer cells focusing on hematologic malignancies. Biochim. 2017; 140:48-57.
You can view some of Dr Natália’s work below and links to her professional profile below.
Research Gate: https://www.researchgate.net/profile/Natalia-Stephanes
Linkedin: https://www.linkedin.com/in/nataliamarceli/
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.
Conclusion
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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References
1.-
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/
2.-
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
3.-
Centers for Disease Control and Prevention (CDC). Tips for Better Sleep [Internet]. Available from: https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html
4.-
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/
5.-
Lie JD, Tu KN, Shen DD, Wong BM. Pharmacological Treatment of Insomnia. P T. 2015 Nov;40(11):759-71. PMID: 26609210; PMCID: PMC4634348. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634348/
6.-
Dujardin S, Pijpers A, Pevernagie D. Prescription Drugs Used in Insomnia. Sleep Med Clin. 2020 Jun;15(2):133-145. doi: 10.1016/j.jsmc.2020.02.002. PMID: 32386689. Available from: https://pubmed.ncbi.nlm.nih.gov/32386689/
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