In this blog post, we are going to answer the question, “Can you take 100 mg Sertraline and 15mg Mirtazapine together?”. Mirtazapine and Sertraline both are antidepressants and they can be used for the management and treatment of depression, anxiety, and a number of other mental health-related problems.

We will discuss the benefits and risks associated with this combination therapy and ways to use them properly to ensure a maximum therapeutic response.

Can you take 100 mg Sertraline and 15mg Mirtazapine together?

Yes, you can take 100 mg Sertraline and 15mg Mirtazapine together, but only if your healthcare provider prescribes you to take them. This combination is considered a good one as it can be used to treat the major depressive disorder (MDD) and treatment-resistant depression.

Several studies have suggested that the combination of Sertraline and Mirtazapine can also be used for the treatment and management of treatment-resistant post-traumatic stress disorder (PTSD).

However, this combination may not work well for everyone because of the possibility of some disturbing side effects. If your doctor has prescribed the combination, you need to take it as properly as possible because overdosing on these meds can become your biggest nightmare.

What is the difference between Sertraline and Mirtazapine?

Sertraline and Mirtazapine are different from each other in terms of the mechanism through which they increase the amount of serotonin in your body. Sertraline is a selective serotonin reuptake inhibitor (SSRI).

It inhibits the reuptake of serotonin by blocking serotonin transporters (SERT), which are usually responsible to take the leftover serotonin back to the presynaptic neuron.

When the SERT is blocked, more serotonin remains available in the synaptic cleft for a longer period of time and it binds to its respective receptors and helps counteract the symptoms associated with depression, anxiety, and several other mental health-related problems.

Mirtazapine, on the other hand, does no such thing. Its exact mechanism of action is still a topic of debate. However, many experts have indicated that Mirtazapine has a dual mode of action. It can activate 5-HT1 receptors, which are one of the serotonin receptors.

It also enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin, while preventing the inhibitory action of the noradrenergic system which hinders the release of serotonin.

One thing which is common with both of these antidepressants is the ability of these meds to increase the number of excitatory neurotransmitters in your brain. Serotonin has receptors in almost every single part of your body, including your gastrointestinal tract.

This neurotransmitter can affect your mood, cognition, reward, learning, memory, hunger, intestinal motility, and several other functions.

What are the side effects associated with the use of Sertraline and Mirtazapine?

Sertraline and Mirtazapine both are associated with some side effects of their own. Let’s look at the side effects individually.

Side effects of Sertraline

Sertraline (Brand name: Zoloft) is associated with a number of side effects. These include:

Nausea
Vomiting
Diarrhoea or Constipation
Acid reflux or heartburn
Abdominal pain
Loss of appetite
Weight gain or loss
Excessive sweating or night sweating (nocturnal/night hyperhidrosis)
Frequent urination
Polydipsia or excessive thirst
Tremors
Muscle twitching and pain
Drowsiness
Dizziness
Excessive tiredness or fatigue
Insomnia or inability to fall asleep
Xerostomia or dry mouth
Dysmenorrhea or heavy periods
Flu-like symptoms, including irritation in eyes and runny nose
Loss of libido in both males and females. Males may suffer from an inability to ejaculate, while females may suffer from inability to have an orgasm.

Side effects of Mirtazapine

Mirtazapine (Brand name: Remeron) is also associated with some side effects. These include:

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

Mirtazapine is also associated with some serious side effects, which may include:

Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc.
Convulsions
QT prolongation
Pain and tightness in the chest
Arrhythmia
Flu like symptoms

Can you take 100 mg Sertraline and 15mg Mirtazapine together?

How to ensure the proper use of Sertraline and Mirtazapine?

Both Sertraline and Mirtazapine require proper dose administration in order to achieve the maximum therapeutic response. When these two are used in combination together, there are some points which are extremely important to understand.

Look out for the warnings

Both of these meds come with a black box warning as they both can induce suicidal behaviour in people less than 24 years of age. However, Mirtazapine can induce suicidal behaviour in people older than that as well.

This is why you should monitor your psychological symptoms carefully. If you are a caretaker of the person or the child receiving this combination therapy, make sure you keep a close eye on their behavioural pattern.

If they seem depressed or ever talk about self-harm, immediately report to your healthcare provider. Closely monitor their other symptoms as well because studies suggest that such people can commit suicide and they have tried in the past as well.

Proper dose administration is the key

You should always be careful when it comes to dose administration. Overdosing on the combination of Sertraline and Mirtazapine can cause a number of complications and may exacerbate the symptoms associated with the mental health condition for which you’re being treated.

If you have accidentally missed a dose, you can take it as soon as you remember. If a lot of time has passed and you’re already near your next dose, it’s best to skip the missed dose and take the next one on time.

Try to take your meds on time and try not to skip a dose, to begin with, but even if you do miss a dose, it’s better to just let it go. A missed dose is always better than an overdose when it comes to antidepressants.

Look out for side effects related to other health conditions

One of the rare and serious side effects of both Mirtazapine and Sertraline is QT prolongation. This side effect can become life-threatening for cardiac patients.

This is why you should always consult your healthcare provider before taking the combination of these two antidepressants. Both are capable of causing arrhythmia and heart palpitations. It can make your heart beat abnormally and can induce a heart attack.

Although monotherapy with either Sertraline or Mirtazapine is considered safe, combination of these two can become dangerous, especially if the doses are not adjusted properly.

Not just cardiac patients, people living with kidney diseases, liver diseases, and metabolic diseases should consult their healthcare provider as they may need a further dose adjustment to process the drugs in their body safely.

Precautions in pregnancy

It is also recommended to inform your healthcare provider if you are pregnant or trying to get pregnant. The use of antidepressants in the third trimester may cause side effects in the growing baby.

You should also inform your doctor if you are a nursing or breastfeeding mother. Both Sertraline and Mirtazapine can pass into the breastmilk and may cause side effects in the breastfed baby.

Conclusion

In this blog post, we have discussed the concomitant use of 100 mg Sertraline and 15 mg Mirtazapine. This combination should only be taken when prescribed by your healthcare provider.

This combination is considered a good one as it can be used to treat the major depressive disorder (MDD) and treatment-resistant depression. However, this combination may not work well for everyone because of the possibility of some disturbing side effects.

If your doctor has prescribed the combination, you need to take it as properly as possible because overdosing on these meds can become your biggest nightmare.

FAQs: 100 mg sertraline and 15mg mirtazapine

What antidepressant can be added to mirtazapine?

With Mirtazapine, you can take SSRIs like Zoloft (Sertraline), Lexapro (Escitalopram), Celexa (Citalopram), Paxil (Paroxetine), and Prozac (Fluoxetine). Mirtazapine can also be paired with Venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI).

The rest of the classes of antidepressants do not pair well with Mirtazapine because of the side effects that are associated with them. However, these combinations may also affect some people negatively, especially when the doses are high.

Is mirtazapine stronger than sertraline?

Both sertraline and mirtazapine are quite strong for the treatment of depression. However, several research studies show that mirtazapine starts working way earlier than sertraline because sertraline can take up to 6 to 12 weeks to produce noticeable therapeutic results.

However, Sertraline may work more effectively in some people as compared to others. Make sure you take the drug which is recommended by your healthcare provider. Do not take any more than the prescribed dose and it is also not recommended to change the frequency of dose administration on your own.

Can mirtazapine and sertraline cause serotonin syndrome?

Yes, Mirtazapine and Sertraline can cause serotonin syndrome, especially when the doses are not adjusted well and are too high for the patient. Both Mirtazapine and Sertraline can increase the level of serotonin and cause the symptoms associated with serotonin syndrome.

This is because too much serotonin, an excitatory chemical in your brain, can make your entire body start malfunctioning. It excessively binds to a huge number of its receptors throughout the body and causes disturbing symptoms. Some of which include:

Nervousness
Convulsions
Confusion
Erratic behaviour
Fever with chills
Muscle Shivering
Rapid change in blood pressure
Uncontrollable heartbeat
Vision problems
Auditory and visual hallucinations

Is 15 mg mirtazapine strong?

Yes, 15mg of mirtazapine is a good initial dose for depression. Normal recommended doses include:

For adults: The treatment is usually started from 15 mg/day, taken usually at morning or whatever time is suggested by your healthcare provider. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 45 mg/day.

For children: Dose is suggested by the doctor according to the condition and body weight.

Is mirtazapine and sertraline a good combination?

Mirtazapine and Sertraline can be a good combination for some people, but you should only take it if prescribed by your healthcare provider. This combination should be used at lower doses. The combination therapy of antidepressants at higher doses can be dangerous.

This is because both of these meds are supposed to increase the amount of excitatory neurotransmitters in your brain. Too much excitatory activity can cause drastic consequences and can increase the risk of a rare condition called serotonin syndrome.

References

Debbie Tallon, Nicola Wiles, John Campbell, Carolyn Chew-Graham, Chris Dickens (2016) – Mirtazapine added to selective serotonin reuptake inhibitors for treatment-resistant depression in primary care (MIR trial): study protocol for a randomised controlled trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526304/
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
A L McRae et al. Expert Opin Pharmacother. 2001 – Review of sertraline and its clinical applications in psychiatric disorders https://pubmed.ncbi.nlm.nih.gov/11336629/
Singh HK, Saadabadi A. – Sertraline https://www.ncbi.nlm.nih.gov/books/NBK547689/

Can you take 100 mg Sertraline and 15mg Mirtazapine together?