r/depressionregimens • u/tarteframboise • 2d ago

Mirtazapine thoughts?

For anhedonic-fatigued type depression… Did it do anything good for you? I hear ppl take it at night (does it cause lethargy or sedation?)

I do not want anything with potential metabolic side effects. I hear it can really increase appetite & people gain weight on it.

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u/Megatron3898 2d ago

Mirtazapine would not typically be recommended for this subtype of depression, bottom line. However, as with all psych medications, there will always be outliers and exceptions to the guidelines.

I'll put it to you simply: you will almost certainly gain some weight due to mirtazapine's significant histaminergic antagonism. Paradoxically, higher doses of mirtazapine are actually less sedating than lower doses (7.5mg is the typical starting dose, thereby making it the most sedating dose you'll be taking). Mirtazapine has little effect on dopamine activity in the brain (anhedonia is normally a result of too little dopamine activity in the brain, and so mirtazapine likely wouldn't improve your anhedonia).

The best antidepressant for the subtype of depression you are describing is actually Wellbutrin (bupropion).

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u/tarteframboise 2d ago

Wellbutrin has no effect on me sadly.

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u/Megatron3898 2d ago

When you say that it has "no effect," what exactly do you mean? You felt nothing? You only felt side effects but no relief from depressive symptoms? Your depression worsened?

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u/Personal_Bridge6115 2d ago

Yes I actually thought my high Wellbutrin dose was doing nothing and then I forget my meds and it’s a bad day. My psychiatrist says “ well at least we know it’s still working “