In this blog post, we are going to answer the question, “Is switching from mirtazapine to trazodone a good option?”. Mirtazapine is an antidepressant which is used to treat a variety of mental health related problems.

However, it may not be tolerated well by every other individual, which can lead to the discontinuation of treatment with mirtazapine. This blog will cover the safety and efficacy of trazodone as compared to mirtazapine.

Is switching from mirtazapine to trazodone a good option?

Yes, switching from mirtazapine to trazodone can be a good option for you if mirtazapine fails to provide adequate therapeutic response. Antidepressants are not easy medications and they are associated with a number of side effects.

Even the safest antidepressant comes with some unwanted effects, but if your antidepressant becomes unbearable for you and does not achieve your desired therapeutic goals, then why not change it?

When mirtazapine causes a number of side effects with zero beneficial effects, then it can be switched to another antidepressant like trazodone. Trazodone is a serotonin specific antidepressant.

It basically agonises the effects of this excitatory neurotransmitter, while inhibiting its reuptake. This way, the amount of serotonin increases in your body to counteract the symptoms associated with depression and other mental health conditions.

Serotonin is a kind of a happy or excitatory chemical in your body that is responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes.

When trazodone starts working, it improves sleep quality, increases appetite, boosts energy levels, reduces the frequency of panic attacks and much more.

One major thing you need to know about antidepressants is, they do not treat depression instantly. So even after stopping mirtazapine, you will have to wait for trazodone to kick in.

What circumstances lead to the discontinuation of mirtazapine?

Following are the common reasons associated with the discontinuation of mirtazapine. These include:

Allergic reaction to mirtazapine

Mirtazapine may cause sudden allergic reactions in various individuals. Allergic reactions are usually associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc.

Make sure you immediately report to your healthcare provider if you observe any allergic reaction after taking mirtazapine or any other medication.

Intolerance

Antidepressants usually start to work within 4 to 6 weeks of treatment. These meds are supposed to be taken daily for several months, according to the severity of your mental health condition.

Some conditions require years and years of treatment, but is it possible if your antidepressant doesn’t suit you? No. It is impossible to live with a medicine that you can’t tolerate well.

This is exactly why antidepressants are often switched a couple of times to finally end up with the one which works the best for you. Mirtazapine may become difficult for some people and they can’t continue the med for a long period of time.

This is why it is often switched to trazodone. Now, one thing to bear in mind is that it’s not necessary that trazodone will work 100% for you. You may or may not tolerate it well.

Inadequate therapeutic response

Mirtazapine may not work well for every individual out there. Several studies have reported that mirtazapine may not produce any beneficial effects in some individuals and it doesn’t help relieve the symptoms of their mental health related problems.

If you continue to take your antidepressant but it does show any sign of relief from your symptoms, it clearly indicates that the drug is not the right choice for you and it can not help to treat your symptoms in the long run.

Trazodone is generally well tolerated and is a good option when you’re switching from one antidepressant to another.

Drug interactions

Mirtazapine may be discontinued because of its ability to interact with other prescription medications. The chance of drug interactions is more common in people who are taking medications daily for the treatment of different chronic illnesses like hypertension, diabetes, asthma etc.

Such meds may interfere with mirtazapine in one way or another and may cause therapeutic failure. This is when the doctor prescribes another antidepressant, usually from a different class, to prevent such drug interactions and all the complications associated with them.

What is the best way to switch from mirtazapine to trazodone?

The best way to switch from mirtazapine to trazodone is by gradually tapering off mirtazapine. Both of these meds can produce sleepiness and they are both present together in your system, it can cause life-threatening hypnosis.

The mirtazapine dose at first should be gradually lowered down below 30mg per day. Some people who are at higher doses may take more time to taper off this antidepressant.

Once you’re below 30mg or at 15mg, you should stay at dose for at least a week or as long as your body takes to adjust to the lower dose. For some people, 15mg mirtazapine can be the last dose before they finally stop using this medication.

However, some people are sensitive to the effects of antidepressants and they may need further dose tapering to ensure safe withdrawal. For such people, most healthcare providers further reduce 15mg mirtazapine to 7.5mg per day.

The treatment with this dose is continued till your body completely adjusts to this dose and that’s when the drug is finally stopped. Once it is discontinued, trazodone is started from the lowest effective dose.

And your body may suffer from mirtazapine withdrawal effects, high doses of trazodone are avoided and your body is given enough time to adjust to the new medication first before escalating the dose.

This step is pretty critical as there’s no way to predict how your body will respond to the presence of trazodone. It is also an antidepressant, and as stated earlier, antidepressants are never free from side effects.

Some people may exhibit signs of an allergic reaction after taking their first ever trazodone dose. People who show good tolerability continue to use trazodone and the dose is gradually increased by the doctor till you reach the most appropriate dose that gives you maximum benefits and minimum side effects.

What are the important points to keep in mind when you switch your antidepressant?

There are few things you need to understand before you switch from mirtazapine to trazodone. These include:

Your new antidepressant might take a few weeks to work

The new drug will not start working overnight. Your body will take its time to adapt to trazodone. Be patient. Don’t lose hope or think that no antidepressant is working for you. Just give it a few weeks, be consistent and maintain a healthy lifestyle.

You may suffer from side effects

Trazodone may produce some unwanted side effects at first, but as your body gets used to it, they will begin to subside. So don’t think that your new med doesn’t suit you, it’s just your body adapting to it. Hang in there!

Common side effects of trazodone include:

Restlessness
Anxiety
Drowsiness
Dizziness
Skin rash
Muscular pain
Joint pain
Headache
Nausea
Vomiting
Tiredness
Sweating
Loss of appetite
Loss of sexual desire

You may experience withdrawal symptoms

As we have discussed how you’re supposed to get rid of mirtazapine out of your system completely, this process can get a little difficult. No matter how properly you follow a taper schedule, you still undergo some withdrawal symptoms.

It depends on the duration of your treatment. If you have been using mirtazapine for quite a while, then you’re more likely to suffer from withdrawal symptoms as compared to people who have used this medication for a short period of time.

Conclusion

In this blog post, we have talked about switching from mirtazapine to trazodone. Both of these are antidepressants and are used for the treatment of a number of mental health related problems.

However, these meds are not easy to deal with and they may not produce the kind of effects you want them to. This is why antidepressants are often switched, till you finally find the perfect one for you.

It can be a nerve-racking process, but you need to be strong during this time. Leaving your depression untreated can make you suffer much more than the treatment.

Make sure you strictly follow your doctor’s recommended taper schedule and never stop antidepressants abruptly. Abrupt withdrawal can lead to disturbing symptoms, which may decrease the quality of your life drastically.

FAQs: switching from mirtazapine to trazodone

Is trazodone stronger than mirtazapine?

Mirtazapine is often considered stronger than trazodone, probably because of its mechanism of action. Mirtazapine acts on both serotonin and norepinephrine, the two important excitatory neurotransmitters. Trazodone, on the other hand, is a serotonin specific antidepressant.

Which is more sedating trazodone or mirtazapine?

Both mirtazapine and trazodone are associated with sedation as a side effect. However, the two can affect people differently. Some people are more sensitive to mirtazapine as compared to others. The combination of mirtazapine and trazodone is associated with life-threatening hypnosis.

Can I take trazodone and mirtazapine at the same time?

No, you should not take trazodone and mirtazapine at the same time. The concomitant use can increase the risk of serotonin syndrome, which is associated with too much serotonergic activity.

Make sure you stick to your doctor’s prescription and don’t take any extra medication that is not advised by your healthcare provider.

Can you switch from mirtazapine to another antidepressant?

Yes, you can switch from mirtazapine to another antidepressant if your healthcare provider recommends it. The choice of new antidepressant and initial dose is also determined by your doctor. It is strictly prohibited to start or stop using any antidepressant without your doctor’s approval.

What to expect when switching antidepressants?

When you switch your antidepressant, it is expected to receive better therapeutic outcomes. One of the possible reasons for antidepressant discontinuation is inadequate therapeutic response.

Better tolerability is another expectation when you switch your antidepressant. It is impossible to live with a medicine that you can’t tolerate well. This is exactly why antidepressants are often switched a couple of times to finally end up with the one which works the best for you.

References

Antidepressant switching guidelines (1998) https://www.nps.org.au/assets/Products/Guidelines-switching-antidepressants_A3.pdf
Nicholas Keks, Director and Adjunct professor, Judy Hope, Deputy director and Senior lecturer, and Simone Keogh, Psychiatrist and senior fellow – Switching and stopping antidepressants https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919171/
K. Outhoff – Switching antidepressants : review https://journals.co.za/doi/10.10520/EJC170556
Strategies and Solutions for Switching Antidepressant Medications https://www.psychiatrictimes.com/view/strategies-and-solutions-switching-antidepressant-medications

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Is switching from mirtazapine to trazodone a good option?