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Remeron vs Elavil
Introduction
For patients dealing with major depressive disorder (MDD) or other forms of depression, certain medications that modify the levels of mood-associated compounds in the brain, known as neurotransmitters, can assist in stabilizing depressive lows and managing symptoms. Remeron and Elavil are two such drugs commonly prescribed for depression. Each influences different neurotransmitters but both have been observed to stabilize mood in individuals suffering from depression. Remeron is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA), primarily affecting norepinephrine and serotonin receptors. On the other hand, Elavil belongs to the class of tricyclic antidepressants (TCAs); it affects several neurotransmitters including norepinephrine and serotonin by inhibiting their reuptake into nerve cells.
Remeron vs Elavil Side By Side
| Attribute | Remeron | Elavil |
|---|---|---|
| Brand Name | Remeron | Elavil |
| Contraindications | Should not be taken with or have recently stopped taking monoamine oxidase (MAO) inhibitors. | Should not be taken with or have recently stopped taking monoamine oxidase (MAO) inhibitors. |
| Cost | For brand name: around $200 for 30 tablets of 15 mg. For generic (mirtazapine): between $4 and $60 depending on quantity and strength. | For brand name: about $20 for 30 tablets of 25 mg. For generic (amitriptyline): prices range from about $2 to just under $60 depending on pack size and strength. |
| Generic Name | Mirtazapine | Amitriptyline |
| Most Serious Side Effect | Thoughts about suicide or self-harm, signs of an allergic reaction, eye problems, rapid heartbeats, low sodium levels, serious nervous system reaction, serotonin syndrome. | Signs of an allergic reaction, new or worsening symptoms of depression, visual problems, heart issues, neurological issues, unusual bleeding. |
| Severe Drug Interactions | MAO inhibitors | MAO inhibitors |
| Typical Dose | Starts at 15 mg/day, can be increased up to 45 mg/day. | Begins at 75 mg/day, can be gradually increased to a maximum of 150-200 mg/day. |
What is Remeron?
Mirtazapine (the generic name for Remeron) is an antidepressant that belongs to the class of drugs known as tetracyclic antidepressants. It was first approved by the FDA in 1996 and its primary function is to increase levels of neurotransmitters norepinephrine and serotonin in the brain, effectively enhancing mood and mental balance. This drug has been prescribed for treating different forms of depression.
Amitriptyline (also known as Elavil), on the other hand, belongs to a class of medications called tricyclic antidepressants (TCAs). Introduced earlier than Mirtazapine, Amitriptyline influences multiple neurotransmitters; it affects not only serotonin but also norepinephrine resulting in a broader spectrum action which may result in more side effects compared to selective meds like Remeron. However, these two drugs are generally well-tolerated depending on individual patient factors.
What conditions is Remeron approved to treat?
Remeron is approved for the treatment of certain mood conditions, including:
- Major depressive disorder (MDD)
- It can also be used off-label for other conditions such as anxiety disorders and insomnia
Elavil is primarily used to treat:
- Depression
- It may also be recommended by your doctor for treating pain from arthritis, cancer, nerve diseases, or other chronic illnesses.
How does Remeron help with these illnesses?
Remeron is used to manage depression by increasing the availability of neurotransmitters in the brain's synapses, specifically serotonin and norepinephrine. It achieves this by hindering their reabsorption back into nerve cells, therefore maintaining higher concentrations for a longer duration. Neurotransmitters like serotonin and norepinephrine are chemical messengers within the brain and body that play crucial roles in mood regulation, cognition, sleep patterns, appetite control among other functions. Lower levels of these neurotransmitters are often associated with depressive states. Consequently, by boosting these neurotransmitter levels, Remeron can alleviate symptoms of depression and aid patients in managing their condition while stabilizing their moods.
What is Elavil?
Elavil is a brand name for amitriptyline, which is a tricyclic antidepressant (TCA). It works by increasing the levels of certain chemicals in the brain that help improve mood. Specifically, it inhibits the reuptake of norepinephrine and serotonin, leading to an increase in the concentration of these neurotransmitters in the synaptic clefts between neurons. Amitriptyline was first approved by FDA back in 1961. As Elavil is not an SSRI or NDRI like Remeron or Wellbutrin respectively, its mechanism and side-effect profile are different from those classes of drugs. For instance, it may result in more anticholinergic side effects such as dry mouth, constipation and urinary retention due to its action on acetylcholine receptors. Its sedative properties can be beneficial for patients suffering from insomnia related to their depression but could also contribute to feelings of fatigue during daytime hours - a distinction from drugs like Remeron that has fewer anticholinergic side effects and less potential for sedation.
What conditions is Elavil approved to treat?
Elavil, known generically as amitriptyline, is approved for the treatment of a variety of conditions including:
- Major depressive disorder (MDD)
- Neuropathic pain associated with various medical conditions
- Migraine prevention
How does Elavil help with these illnesses?
Amitriptyline, sold under the brand name Elavil among others, is a tricyclic antidepressant that works by increasing norepinephrine and serotonin levels in the brain. These neurotransmitters are involved in many bodily processes including mood regulation, alertness and focus. Low levels of these chemicals have been linked with depression symptoms. Elavil also has an effect on other neurotransmitters such as acetylcholine which may contribute to its therapeutic effects but could potentially lead to side effects like dry mouth or blurred vision.
Elavil can be considered when patients do not respond adequately to newer classes of antidepressants like selective serotonin reuptake inhibitors (SSRIs), for instance Remeron (mirtazapine). Moreover, sometimes it might be combined with other types of medications depending on individual patient's condition. However despite its effectiveness, due to potential side-effects and safety concerns related to overdose it tends to be used less frequently than newer generation antidepressants.
How effective are both Remeron and Elavil?
Both mirtazapine (Remeron) and amitriptyline (Elavil) have been extensively used in the treatment of depression, with Elavil having a longer history as it was approved by the FDA earlier. They both act on similar neurotransmitters - serotonin and norepinephrine - but they do so in different ways, which may lead to their use under varied circumstances. The effectiveness of Remeron and Elavil in treating depressive symptoms has been directly studied; both drugs showed comparable efficacy levels and encouraging safety profiles.
A 2001 review of meta-analysis reports on mirtazapine demonstrated that its antidepressant effects can begin from the first week of treatment. It also revealed that compared to several other antidepressants, mirtazapine's side effect profile is more favorable due to lesser sexual side effects or gastrointestinal disturbances. Additionally, it noted that mirtazapine is well-tolerated across diverse patient populations.
Comparatively, research indicates amitriptyline could be more effective than placebo for depressive disorders but might not be as efficacious as some contemporary antidepressants. Nonetheless, given its versatile pharmacological profile including potent anticholinergic properties, amitriptyline may serve particular therapeutic needs like chronic pain associated with depression or insomnia due to its sedative effects. However, because it's an older generation tricyclic antidepressant (TCA), data confirming its efficacy as a stand-alone treatment are less robust compared to newer agents like SSRIs or even Remeron itself given significant adverse events related to TCAs such as cardiac toxicity issues. Due to this factor along with others such as weight gain potential and anticholinergic burden leading possibly towards cognitive impairment especially in elderly patients make Elavil typically considered only after first-line treatments have failed or when specific clinical conditions necessitate its usage despite these concerns.
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At what dose is Remeron typically prescribed?
Oral dosages of Remeron (Mirtazapine) usually start at 15 mg/day, with studies suggesting that this is typically sufficient for treating major depressive disorder in most adults. For more severe cases or if there's no response after a few weeks, the dosage can be increased up to 45 mg/day under medical supervision. On the other hand, Elavil (Amitriptyline) doses typically range from 75-150 mg/day in divided doses for adults with depression. However, lower initial doses may be recommended and then gradually increased over time based on patient response and tolerance. It should be noted that both these medications are not generally recommended for children and adolescents unless specifically prescribed by a healthcare professional.
At what dose is Elavil typically prescribed?
Elavil treatment typically begins at a dosage of 75 mg/day, divided into two or three smaller doses. Depending on the patient's response and tolerance, this can be gradually increased to a maximum of 150-200 mg/day. In hospital settings or under close medical supervision, higher dosages may be used in some cases. The maintenance dosage usually ranges from 40-100 mg daily given either as a single bedtime dose or in divided doses spaced throughout the day. It is important to remember that responses to antidepressants like Elavil can take several weeks to fully manifest, so adjustments should not be made hastily without thorough assessment of efficacy and side effects.
What are the most common side effects for Remeron?
Common side effects of Remeron (mirtazapine) include:
- Drowsiness/sleepiness
- Increased appetite
- Weight gain
- Dizziness
- Dry mouth
- Constipation
As for Elavil (amitriptyline), common side effects may consist of:
- Drowsiness/sleepiness
- Dry mouth
- Lightheadedness or dizziness, particularly when standing up quickly
- Urinary retention (difficulty urinating)
- Blurred vision
-Nausea, vomiting and loss of appetite.
These medications can also potentially cause more serious side effects like suicidal thoughts, changes in sexual desire/ability, and irregular heartbeats. If you experience any severe symptoms while taking either medication, it's important to seek medical attention promptly.
Are there any potential serious side effects for Remeron?
While both Remeron and Elavil are antidepressants, they can have different side effects. On rare occasions, the use of Remeron may lead to:
- Thoughts about suicide or self-harm
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Eye problems such as blurred vision or eye pain
- Rapid heartbeats that might make you feel like you're on the verge of fainting
- Low sodium levels - this can result in symptoms ranging from headaches and confusion to severe weakness and loss of coordination.
In extremely rare cases, some people may experience a serious nervous system reaction leading to very rigid muscles, high fever, sweating, confusion and fast or uneven heartbeats.
Serotonin syndrome is another potential risk – if you notice agitation, hallucinations, fever/sweating/shivering combined with muscle stiffness/twitching/loss of coordination along with nausea/vomiting/diarrhea then seek medical attention immediately.
What are the most common side effects for Elavil?
Elavil, also known as Amitriptyline, may bring about certain side effects such as:
- Dry mouth and a sore throat
- Blurred vision or visual disturbances
- Constipation or nausea
- Difficulty sleeping (insomnia)
- Nervousness or anxiety
- Sweating excessively
- Rapid heart rate
- Possible confusion, agitation or increased hostility
- Skin rash on rare occasions
- Unintended weight loss in some cases
- Frequent urination
-Dizziness and headaches are common too.
In addition to these potential issues, you might also experience muscle stiffness or pain in your joints when taking Elavil. Always consult with your healthcare provider if any of these symptoms persist for longer periods or become more severe.
Are there any potential serious side effects for Elavil?
Elavil, although typically well-tolerated, can sometimes cause severe side effects. These may include:
- Signs of an allergic reaction such as difficulty breathing; swelling of your face, lips, tongue or throat
- New or worsening symptoms of depression: thoughts about suicide or dying; new behavior changes such as mood swings, agitation, panic attacks
- Visual problems like blurred vision, tunnel vision and seeing halos around lights.
- Heart issues including chest pain and fast/irregular heartbeats
- Neurological issues like a seizure (convulsions); confusion; sudden weakness or ill feeling
- Unusual bleeding from the nose/mouth/vagina/rectum.
If you happen to experience any of these symptoms while on Elavil therapy, it is essential that you seek immediate medical attention.
Contraindications for Remeron and Elavil?
Both Remeron and Elavil, like other antidepressants, might worsen symptoms of depression in some individuals. If you notice your depression getting worse or if there's an increase in suicidal thoughts or behaviors, it is crucial to seek immediate medical attention.
Neither Remeron nor Elavil should be taken if you are currently taking or have recently stopped taking monoamine oxidase (MAO) inhibitors. It is always important to inform your healthcare provider about all medications that you're presently on; MAOIs need approximately two weeks to clear out from your system before starting either Elavil or Remeron so as to avoid any potentially dangerous interactions between these drugs. Please consult with your doctor for appropriate guidance.
How much do Remeron and Elavil cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Remeron (15 mg) averages around $200, which works out to approximately $6.66/day.
- The price of 30 tablets of Elavil (25 mg) is about $20, working out to roughly $0.67/day.
Thus, if you are on a lower dosage for Remeron (i.e., below or at 15mg per day), then brand-name Elavil is significantly less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions mirtazapine (Remeron) and amitriptyline (Elavil), costs are considerably lower:
-
Mirtazapine can be found in packs from 7 up to 84 tablets with approximate costs varying between $4 and $60 depending on quantity and strength, potentially bringing your daily cost down as low as about $0.05 - over one hundred times cheaper than branded Remeron.
-
Amitriptyline also comes in various quantities starting from packages as small as seven pills all the way up to several hundreds with prices ranging anywhere from about two dollars up to just under sixty dollars depending again on pack size and strength – but almost always coming in significantly cheaper than its branded counterpart Elavil with potential savings making it close to ten times less expensive at every comparable dose level.
Popularity of Remeron and Elavil
Mirtazapine, commonly known by its brand name Remeron, was prescribed to about 4.2 million people in the United States in 2020. Accounting for around 8% of antidepressant prescriptions in the US, mirtazapine is classified as an atypical antidepressant – it works differently than SSRIs and most other classes of antidepressants. The prevalence of mirtazapine use has shown a steady increase since its approval by FDA.
Amitriptyline, also popularly recognized by the brand name Elavil, was prescribed to approximately 3.5 million individuals throughout the USA during 2020. In the US prescription landscape, amitriptyline represents just above 7% of tricyclic antidepressant (TCA) prescriptions and makes up just under 5% of total antidepressant prescriptions nationwide. Unlike newer drugs like mirtazapine that have been consistently increasing in usage over recent years, amitriptyline's prevalence has largely remained constant over the past decade.
Conclusion
Both Remeron (mirtazapine) and Elavil (amitriptyline) have long-standing records of usage in patients with depression, supported by numerous clinical studies and meta-analyses indicating that they are more effective than placebo treatments. In certain cases, the two drugs may be used concurrently, but this decision is subject to careful evaluation by a physician as they can interact negatively with one another. Due to their different mechanisms of action - Remeron primarily acting on norepinephrine and serotonin receptors while Elavil works mainly on several neurotransmitters including acetylcholine, histamine H1, and various serotonin receptors - these medications are usually prescribed under different circumstances.
Remeron is typically considered a first-line treatment option for major depressive disorder whereas Elavil would often be considered as an adjuvant therapy (addition) to other antidepressants or in patients who haven't responded well to SSRI/SNRI class antidepressants or those who need additional pain relief benefits provided by Elavil.
Both medications are available in generic form which represents significant cost savings especially for patients paying out-of-pocket. Both Remeron and Elavil may require an adjustment period during which effects might not be immediately noticeable.
The side effect profile varies between the two drugs: both generally well-tolerated but with notable differences such as amitriptyline being more likely associated with anticholinergic side effects like dry mouth or constipation than mirtazapine. Mirtazapine frequently induces weight gain which needs consideration depending upon patient's health status. For both drugs, it’s important that patients closely monitor their mood changes particularly when starting treatment; any worsening depression symptoms or suicidal thoughts should prompt immediate medical consultation.
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Refrences
- Kasper, S., Praschak-Rieder, N., Tauscher, J., & Wolf, R. (1997, October). A Risk-Benefit Assessment of Mirtazapine in the Treatment of Depression. Drug Safety. Springer Science and Business Media LLC.http://doi.org/10.2165/00002018-199717040-00005
- Trivedi, M. H., Desaiah, D., Ossanna, M. J., Pritchett, Y. L., Brannan, S. K., & Detke, M. J. (2008, May). Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. International Clinical Psychopharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/yic.0b013e3282f41d7e
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