The Impact of Mirtazapine on Addiction Recovery

There are many aspects to treating substance abuse disorders, ranging from psychological therapy to social mutual support groups, and even certain medicines.
 
According to the National Institute of Drug Abuse, medication in combination with other treatments can be an essential part of drug addiction recovery.

Mirtazapine is a drug that has been shown in studies to provide supportive benefits in substance abuse rehab, specifically for helping to maintain abstinence from various substances, including alcohol, methamphetamines, cocaine, and opiate drugs, among potential others.

What Is Mirtazapine?

MedicationMirtazapine – known in the U.S. alternatively as brand names Remeron® or Remeron SolTab – is an antidepressant that works by balancing aspects of brain chemistry, including norepinephrine and serotonin. According to an article through the Stanford University of Medicine, the medication has also shown some capabilities in treating anxiety, obsessive-compulsive disorder, and panic disorder, among other psychological disorders.

According to medication information through the Federal Drug Administration (FDA), Mirtazapine was developed by a company named Organon and approved by the FDA in 1996. Organon later came out with another version of the medication, Remeron SolTab, approved in 2001. In 2007, Organon was bought by Schering-Plough, which continued to market the medication. Mirtazapine is known under various other brand names in other countries; it is no longer under patent, which enables it to be distributed generically.

Mirtazapine is analogous to a medication not available in the U.S. called mianserin. Both medications act in the same way and are considered to be less dangerous in overdose than most other antidepressants.

The medication was originally intended for treating major depression, but has since been tested and investigated for a number of other uses, including:

  • Insomnia
  • Generalized and social anxiety
  • Obsessive-compulsive disorder
  • Post-traumatic stress
  • Appetite stimulation
  • Sleep apnea
  • Schizophrenia

These off-label uses include drug addiction treatment; mirtazapine has not yet been approved by the FDA for treatment of addiction disorders.

According to the drug information provided through Drugs.com, dosages of 15 milligrams (mg), 30 mg, and 45 mg are the most common, though higher doses have been given and there is a 7.5 mg tablet. The 15-45 mg tablets also come in an orally dissolving form. The dose is taken once daily, usually near bedtime due to the drug’s relaxing effect. It can be taken with or without food.

Research shared through the National Institutes of Health shows that the half-life of the substance ranges between 20 and 40 hours. It begins to take effect quickly, and only needs to be taken once daily.

According to drug information published in the National Alliance on Mental Illness, commonly reported side effects include:

  • Sleepiness or sedation
  • Increased appetite and potential weight gain
  • Dizziness
  • Increased cholesterol/triglycerides

More serious side effects have occurred, including symptoms resulting from sudden withdrawal from the drug. Nevertheless, mirtazapine is considered to be safer than many other antidepressants, particularly in the case of overdose, as reported in a report in Pharmacotherapy. Like most antidepressants, it can be more dangerous if taken with alcohol or with certain other drugs, such as monoamine oxidase inhibitors (MAOIs), which are other types of antidepressants, such as rasagiline or phenelzine.

Mirtazapine in Addiction Treatment

Because of the way mirtazapine acts in the body, it has been considered for use in treating addictions of various kinds, including but not limited to:

  • Alcohol
  • Benzodiazepines (benzos)
  • Opiate substances
  • Cocaine
  • Marijuana

As mentioned above, mirtazapine acts on serotonin balance. Based on recent research in the journal Behavioral Brain Research, most psychoactive drugs affect the serotonin system in the brain, and consistent use or abuse can cause adaptive changes in that system that coincide with the addictive cycle. In other words, substance abuse causes changes in the ways serotonin is created and used in the body, which in turn contributes to the development of addictive behaviors. This occurs in combination with other factors, such as genetic dispositions and other brain chemistry pathways.

recoveryMirtazapine also affects the production and use of norepinephrine, a stress hormone produced in the adrenal glands. The anxiety response that is common in some drug addictions, like those of opiates and cocaine, is correlated to changes in norepinephrine function caused by the substances that are being abused, as explained in an article in the Biological Psychiatry journal.

Even before this research came out, mirtazapine was tested for use in treating addiction to various substances. According to a review published in Pharmacology & Therapeutics, multiple research reports and case studies indicate that the medication shows promise in helping people manage substance addiction.

Because of the medication’s action in several different areas of brain chemistry, it appears that mirtazapine can help to calm cravings and reduce drug-seeking behaviors. Also, in clinical cases involving opiate drugs and co-occurring alcohol and depression, and in a study of people being treated for depression, mirtazapine was able to help not only reduce drug cravings, but also reduce the co-occurring psychological issues.


The most effective way to use mirtazapine in treatment for substance abuse disorders is in combination with psychological and social counseling and support in a full-scope addiction treatment program.


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