Mirtazapine vs Xanax: Can you use these two together? 

In this blog post, we are going to talk about the possible interactions between mirtazapine and xanax. Mirtazapine is an antidepressant which is used to treat a number of mental health related problems. 

Xanax is an anti-anxiety medication and it is also used for a number of health conditions. This blog will help you understand the safe and efficacy of these two agents. 

Can you use mirtazapine and xanax together?

Yes, you can use mirtazapine and xanax together, but only when your healthcare provider has prescribed this combination. Several studies indicate that xanax can be used together with mirtazapine for the treatment of anxiety comorbid with depression and insomnia. 

However, the dose at which you take xanax can make a huge difference and it is also not recommended to use xanax for a long period of time because of its addictive properties. It is not recommended to use any combination of meds without your doctor’s approval. 

Several researchers have studied the combined effects of xanax and antidepressants on the patients with major depressive disorder (MDD) and generalised anxiety disorder (GAD). 

A 2008 study concluded that the combination therapy of mirtazapine and benzodiazepines may result in more successful outcomes as compared to monotherapy. The same study also indicated the importance of dose adjustment to maximise beneficial effects and minimise the side effects. 

A 1988 study monitored the antidepressive effects of xanax (alprazolam) and observed six case studies, four of which showed great outcomes, similar to those of Tricyclic antidepressants (TCAs), but with less side effects. 

This indicates that xanax itself possesses antidepressant properties but the mechanism through which it works to counteract the symptoms of depression is still unknown. 

Another study indicated the chances of xanax induced addiction and the fact that prolonged treatment becomes extremely hard to stop. One thing that comes directly in mind from the word ‘addiction’ is mood instability which follows when it’s time to stop using such a med. 

This creates a barrier between mirtazapine and its beneficial effects, just because the patient undergoes xanax withdrawal syndrome, which has pretty disturbing symptoms including:

• Panic attacks
• Mania
• Paranoia 
• Hyperventilation 
• Anxiety relapse
• Mood instability 
• Loss of appetite 
• Insomnia
• Muscle cramps and weakness
• Fatigue 
• Photosensitivity 
• Excessive sweating 
• Malaise 
• Hallucinations 
• Delirium 
• Dementia 
• Convulsions 

These symptoms can vary from person to person and it depends on the dose and the duration of treatment with xanax. These withdrawal symptoms here are speaking for themselves and you can imagine how these symptoms can interfere with your depression treatment. 

This is exactly why the duration of xanax use is confined to the time period taken by mirtazapine to kick in. 

However, this is not always the case. In major anxiety disorders, this combination can be used for a prolonged period of time, but the doses are determined carefully, in order to prevent addiction and side effects. 

What are the risks associated with the concomitant use of mirtazapine and xanax?

Both mirtazapine and xanax are associated with few side effects, which can vary from person to person. 

The concomitant use may increase the risk of drowsiness, low mental alertness, impaired motor functions, confusion, forgetfulness etc, but these side effects depend on the doses you’re at. 

Side effects are not just the effects of your drug but also how your body responds to the drug. Xanax is generally well tolerated, but some people may suffer from the side effects and might even stop the treatment because of them. 

It depends on the pre-existing health conditions as well. One of the side effects of benzodiazepines include respiratory depression, which is dose dependent. 

A person with normal respiratory function might not even notice this side effect on the normal therapeutic dose, but people with chronic breathing disorders like asthma, chronic obstructive pulmonary disease (COPD) and emphysema etc, can suffer from significant breathing difficulties. 

Similarly, mirtazapine is considered safe to be used in cardiac patients, but it could cause QT elongation and make pre-existing arrhythmia even worse. Xanax is also known for causing an addiction, which is why it is not suitable for prolonged use. 

Doctors usually recommend using it as long as your antidepressant kicks in. After that, both anxiety and depression can be managed by mirtazapine and xanax is slowly tapered off because it is not safe to use benzodiazepines for a long period of time. 

Both pharmacodynamics (how a drug affects your body) and pharmacokinetics (how your body affects a drug) are considered. 

It is always best to consult your healthcare provider and be certain that the combination of meds you’re about to use is compatible with any underlying health condition you might have. It is also important to make sure that all of your meds are compatible with one another. 

The most common side effects solely related to the use of mirtazapine 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 chest
• Arrhythmia 
• Flu like symptoms 

Side effects associated with the use of xanax include:

• Dizziness
• Tiredness or fatigue 
• Drowsiness 
• Muscle pain
• Vision problems 
• Headache 
• Hypersomnia 
• Forgetfulness 
• Troubled or intrusive thoughts
• Impairment of motor coordination 
• Constipation or diarrhoea 
• Nausea 
• Vomiting 
• Increased or decreased appetite 

Some serious and rare side effects of xanax include:

• Allergic reaction associated with symptoms like redness of skin, itching, painful blisters, blue-purple patches, burning sensation etc. 
• Serious respiratory depression which lowers down breathing rate and can decrease the availability of oxygen in the blood. It could be life-threatening for people suffering from asthma or chronic obstructive pulmonary disease (COPD) 
• Terrible addiction 
• Dementia 
• Abnormal behaviour
• Blackouts 

These side effects, as mentioned earlier, are rare and serious. It is impossible to predict your body’s response to either one medicine or the combination of these two meds. 

The side effects can also relate to the underlying health condition. Make sure you ask your doctor before using any medication and it is strictly prohibited to use someone else’s prescription medication. 

When to call your doctor? 

• Immediately talk to your healthcare provider if you experience unusual side effects while taking mirtazapine and xanax together.

• Inform your doctor if you’re pregnant, trying to conceive. Xanax should not be used by pregnant women and mirtazapine can also be dangerous for the fetus, especially when used in the third trimester. 

• Inform your doctor if you’re a breastfeeding mother. Both of these drugs are capable of passing into the breastmilk and may cause side effects in newborns. 

• Do not stop mirtazapine or xanax abruptly. If it’s time for you to stop one or both of these meds, your doctor will simply recommend a taper schedule for you, which should be followed vigilantly if you wish to keep withdrawal symptoms at bay. 

• Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 

Conclusion

In this blog, we have discussed the safety, efficacy and possible interactions associated with the use of mirtazapine and xanax together. Several studies showed that xanax and other benzodiazepines can be used to control early anxiety caused by mirtazapine. 

The treatment is usually continued till your antidepressant kicks in. Both mirtazapine and xanax are associated with few side effects, which can vary from person to person. 

The concomitant use may increase the risk of drowsiness, low mental alertness, impaired motor functions, confusion, forgetfulness etc, but these side effects depend on the doses you’re at. High doses of both the meds can make you vulnerable to CNS side effects. 

It is important to ask your mental healthcare professional before using any such medications along with your antidepressants. Benzodiazepines should be used with caution because of its addiction-causing properties. 

FAQs: mirtazapine vs xanax

Is mirtazapine similar to Xanax?

No, mirtazapine and xanax are two separate meds with different mechanisms of action. Mirtazapine belongs to the tetracyclic antidepressants. It has a dual mode of action. 

Mirtazapine is believed to be responsible for the activation of 5-HT1 receptors, which are one of the serotonin receptors. This antidepressant also acts on the noradrenergic system. 

Xanax, on the other hand, is a brand name for alprazolam, which is one of the oldest benzodiazepines. It is used to help control anxiety, convulsions and panic attacks. This medication basically mimics inhibitory chemicals in your brain, like GABA, to control the excessive neuronal activity. 

Is mirtazapine 15 mg like Xanax?

No, mirtazapine and xanax are entirely different from one another, no matter the strength of the dose. However, both of these meds can be used to induce sedation and help relieve the symptoms associated with insomnia. Make sure you use these meds only if recommended by your healthcare provider. 

Does mirtazapine calm you down?

Yes, mistrazapne does possess anti-anxiety properties and can help you calm you down a little. Mirtazapine can significantly help improve your sleep cycle by providing relief in the disturbances that might occur when you try to fall asleep. It also increases the duration of your sleep and reduces the frequency of nighttime wakefulness, especially in people who have insomnia comorbid with depression. 

Is mirtazapine a narcotic?

No, mirtazapine is not a narcotic drug. Mirtazapine (Brand name: Remeron) is an antidepressant. It belongs to the tetracyclic antidepressants. It has a dual mode of action. Mirtazapine is believed to be responsible for the activation of 5-HT1 receptors, which are one of the serotonin receptors. 

This antidepressant also acts on the noradrenergic system. Experts believe that remeron enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin. It also prevents the inhibitory action of the noradrenergic system which hinders the release of serotonin. 

What drugs should not be taken with alprazolam?

• Antifungals and antivirals. They may inhibit the metabolism of clonazepam and cause toxicity. 
• Antiepileptics. The concomitant use may decrease the beneficial effects of clonazepam. 
• Anti-allergy medications. The concomitant use increases the risk of sedation 
• Narcotic analgesics or any other controlled substance. The concomitant use can cause serious CNS side effects. 
• Sleeping pills
• Other anxiolytics and tricyclic antidepressants (TCAs). 

What should you not take 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 

References

• Drug Interactions between mirtazapine and Xanax https://www.drugs.com/drug-interactions/mirtazapine-with-xanax-1640-0-133-54.html#:~:text=Using%20ALPRAZolam%20together%20with%20mirtazapine,%2C%20judgment%2C%20and%20motor%20coordination.
• 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 
• M D Warner et al. J Clin Psychiatry. (1988) – Alprazolam as an antidepressant https://pubmed.ncbi.nlm.nih.gov/3281931/
• Nassima Ait-Daoud, MD, Allan Scott Hamby, MD, and Derek Blevins, MD (2018) – A Review of Alprazolam Use, Misuse, and Withdrawal https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/#__ffn_sectitle