Can mirtazapine cause breathlessness? (3+ conditions put you at risk) 

In this blog post, we are going to answer the question, “Can mirtazapine cause breathlessness?”. Mirtazapine is an antidepressant which is used to treat a number of mental health related problems. 

However, this medicine can cause a number of side effects including breathlessness. This blog will cover what type of people are at risk of developing this side effect and what could be done if you’re one of the unfortunate ones. 

Can mirtazapine cause breathlessness?

Yes, mirtazapine can cause breathlessness in around 1-1.5% of people taking this antidepressant. This breathlessness can either be due to an immediate allergic reaction to mirtazapine or it can develop over time. However, it is not that common and may depend on other factors. 

Many researchers have studied the effects of mirtazapine on respiratory functions. Such side effects are found more common in people who are allergic to mirtazapine to some extent. If shortness of breath occurs right after taking the first dose of mirtazapine, it indicates that it is not the right choice of antidepressant for you. 

Several studies showed that mirtazapine overdose can have a fatal impact on pre-existing asthma by causing bronchoconstriction. Overdosing on low strength mirtazapine would not produce as dangerous effects as a high dose would produce. 

One study revealed that treatment with mirtazapine can actually help relieve the breathlessness associated with some mental health conditions. 

The team studied breathing issues during sleep and tried to treat it with mirtazapine. The result concluded that mirtazapine improved nocturnal breathlessness to some extent just after 6 to 8 weeks of treatment. 

Another study suggested that lung conditions, including chronic obstructive pulmonary disease (COPD), often cause depression and panic attacks which can exacerbate the symptoms of breathlessness. 

This effect can significantly reduce after the treatment of such people with mirtazapine. Some studies suggest that people and their pre-existing health conditions react differently to medications. 

Some asthmatic patients could not tolerate mirtazapine and it resulted in discontinuation of the treatment. These research studies can help us understand that mirtazapine produces variable effects on people. 

It is best to discuss your pre-existing health conditions with your healthcare professional before starting antidepressants or any other medication.

Who is at risk of developing mirtazapine induced breathlessness? 

People involved with following health conditions are at greater risk of developing mirtazapine induced shortness of breath:

Chronic breathing difficulties 

People who live with chronic breathing problems like COPD or asthma, are at constant risk of developing breathing difficulties associated with side effects. This is because their respiratory immunity is compromised. 

Chain smoking

Smoking is well known for causing breathing difficulties. It puts people at high risk of chronic obstructive pulmonary disease (COPD), emphysema and lung cancer. 

It can also exacerbate the medication induced shortness of breath and puts you at high risk of developing such side effects in the first place. Make sure you cut back on smoking as much as you can. 

High cholesterol levels

Shortness of breath is a symptom of high cholesterol levels itself. When such a person takes mirtazapine, he or she is at high risk of developing shortness of breath. 

Elevated HDL levels can cause multiple factors difficulties in people including coronary artery diseases. Make sure your cholesterol levels are within the normal ranges. 

Obesity

Obesity is another condition that puts you at greater risk of developing multiple diseases. Having excess body fat can make your body extremely heavy and damage your metabolism. 

This puts pressure on your heart and lungs to supply blood and oxygen to every single cell of your body, resulting in shortness of breath and high blood pressure. 

It’s best to try different healthy methods to shed those troublesome pounds, before they create even more complications for you. 

Anaemia 

Anaemia is a condition in which your red blood cells are not as many as they should be. This results in decreased oxygen supply to your cells. To compensate for this condition, your lungs have to work much harder, which is why you experience shortness of breath. 

Such anaemic people are more likely to suffer from mirtazapine induced breathlessness at higher doses.

Hypotension 

Low blood pressure or blood volume can cause breathlessness and can worsen your side effects. Make sure your blood pressure is normal. 

Allergies

People who are allergic to mirtazapine or any other excipients present in the formulation are more likely to suffer from breathlessness, with or without tightening of chest, wheezing or dizziness.

If you suffer from such conditions right after taking your first ever dose of mirtazapine, immediately talk to your healthcare provider. 

Is there anything that may help overcome your mirtazapine induced breathlessness? 

Talk to your doctor. Discuss your side effects and make sure you’re at the right dose of mirtazapine, as studies have suggested that this side effect is dose dependent. Higher doses can cause more pronounced side effects as compared to lower doses. 

Do not smoke or drink excess of alcohol. These two habits can worsen not one, but many other side effects of mirtazapine. Have a cup of black coffee. Studies suggest that caffeine can help relieve breathlessness, but as I said earlier, have a cup of coffee. 

Don’t increase your caffeine intake drastically if you don’t wish to be subjected to nerve-racking anxiety. Maintain a healthy weight as people who are overweight or obese are more likely to suffer from mirtazapine induced breathlessness. 

Consult your doctor to rule out any underlying health condition. Monitor your trigger factors, if any. Maintain a healthy diet and sleep at least 7 to 8 hours every night. 

When to call your doctor? 

Immediately consult your healthcare provider if you:

• Feel your breathlessness getting worse
• Feel tightening in your chest, along with wheezing 
• Are not getting enough oxygen in your brain and exhibit symptoms like dizziness, excessive sweating, losing your balance or blackouts. 
• Experience unexplained weight gain or loss 

What other medications are responsible to cause shortness of breath? 

Following are some other medications which can cause shortness of breath:

• Antihypertensive agents, including ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, beta blockers etc. 
• Non-steroidal anti-inflammatory drugs, including naproxen, ibuprofen, diclofenac etc. 
• Anticonvulsants/Antiepileptics /drugs to treat seizures, including carbamazepine, sodium valproate etc. 
• Antibiotics, including macrolides (azithromycin, clarithromycin etc), fluoroquinolones (ciprofloxacin, levofloxacin, etc), aminoglycosides (streptomycin). 
• Chemotherapeutic agents or drugs to treat cancer, including vinca alkaloids, taxanes, anthracycline antibiotics etc. 
• Illicit drugs, including heroine, cocaine, morphine, ephedrine, amphetamines, ecstasy etc. 

Make sure you don’t use the above mentioned drugs with mirtazapine. Some drugs, when used concomitantly, cause synergistic side effects which are much more pronounced than side effects products by these drugs individually. 

Drug interactions should be an important consideration before taking two or more medicines together. Yes, drugs in combination are often used to achieve better therapeutic response but this is not the case with every interaction. 

Some drugs are highly incompatible with one another. They often cancel out each other’s effects or antagonise them. Some drugs are so incompatible that they end up changing the entire chemical composition of one another. 

Some interfere with metabolism or bioavailability (the rate and extent at which the active drug moiety enters systemic circulation/blood). This can lead to drug accumulation in different parts of the body. 

It is always advised to inform your healthcare provider of any medicine you take before getting a new prescription. Your doctor will make sure not to prescribe any such drug which might interfere with those you are already taking. 

Conclusion 

In this blog post, we have discussed mirtazapine induced breathlessness. This breathlessness can either be due to an immediate allergic reaction to mirtazapine or it can develop over time. However, it is not that common and may depend on other factors. 

Many researchers have studied the effects of mirtazapine on respiratory functions. Such side effects are found more common in people who are allergic to mirtazapine to some extent. If shortness of breath occurs right after taking the first dose of mirtazapine, it indicates that it is not the right choice of antidepressant for you. 

Make sure you use this medication or any other medication only when your doctor has advised it. Using medications which can affect your brain is not something ideal and should not be encouraged unless it is absolutely necessary to do so. 

FAQs: Can mirtazapine cause breathlessness

Can mirtazapine help with shortness of breath?

One study revealed that treatment with mirtazapine can actually help relieve the breathlessness associated with some mental health conditions. Another study suggested that lung conditions, including chronic obstructive pulmonary disease (COPD), often cause depression and panic attacks which can exacerbate the symptoms of breathlessness. This effect can significantly reduce after the treatment of such people with mirtazapine.

Does mirtazapine cause respiratory depression?

Mirtazapine does not necessarily cause respiratory depression, but it can cause breathlessness in around 1-1.5% of people taking this antidepressant. This breathlessness can either be due to an immediate allergic reaction to mirtazapine or it can develop over time. However, it is not that common and may depend on other factors. 

What are the most common side effects of mirtazapine?

• Sleepiness or drowsiness 
• Excessive tiredness or fatigue 
• Dizziness or lightheadedness 
• Xerostomia or dry mouth 
• Anxiety 
• Agitation 
• Confusion 
• Gain of appetite
• Weight gain 
• Gastrointestinal side effects including nausea, vomiting and diarrhoea/Constipation 

What drugs should not be taken with mirtazapine? 

• Monoaminoxidase inhibitors (MAOIs). The combination use can increase the risk of serotonin syndrome. 
• Non-steroidal anti-inflammatory drugs (NSAIDS). The combination use can increase the risk of bleeding. 
• Pimozide. The concomitant use can increase the plasma concentration(availability of a drug in the blood) of pimozide to much higher levels. It can result in life-threatening arrhythmia.
• Controlled substances, including all narcotic analgesics. The concomitant use can cause severe psychological side effects. 
• Mood stabilisers 
• Alcohol 

Is mirtazapine good for anxiety?

Yes, mirtazapine is good for anxiety. Anxiety is a mental health condition associated with general worry or anxiety about pretty much everything without having any logical reason. People suffering from GAD worry about small matters related to family, friends, relationships, study, work, health, wealth etc. 

Does your brain go back to normal after antidepressants?

Your brain does go back to normal after you stop using antidepressants, but it takes time and this time taken depends on the duration of your antidepressant therapy. It could take up to 10 months to go back to your normal serotonin levels, after long-term antidepressant therapy.

References 

• Natasha Lovell et al. Palliat Med. (2018) – Use of mirtazapine in patients with chronic breathlessness: A case series https://pubmed.ncbi.nlm.nih.gov/30028237/
• Mirtazapine Tablet – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-13706-4047/mirtazapine-oral/mirtazapine-oral/details#:~:text=Mirtazapine%20is%20used%20to%20treat,(neurotransmitters)%20in%20the%20brain.
• National Library of Medicine – Mirtazapine https://medlineplus.gov/druginfo/meds/a697009.html