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Remeron vs Seroquel
Introduction
For patients with major depressive disorder (MDD) or related conditions, certain medications that influence the levels of neurotransmitters, brain compounds linked to mood, can assist in stabilizing emotional lows and managing symptoms. Remeron (generic name Mirtazapine) and Seroquel (generic name Quetiapine) are two such drugs typically prescribed for depression. Both have unique effects on different neurotransmitters but share a common aim of stabilizing mood in people with depression. Remeron is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA), primarily influencing norepinephrine and serotonin receptors. On the other hand, Seroquel falls under the category of atypical antipsychotics. It affects several neurotransmitter systems in the brain including dopamine, serotonin, histamine, and adrenergic signaling pathways.
Remeron vs Seroquel Side By Side
| Attribute | Remeron | Seroquel |
|---|---|---|
| Brand Name | Remeron | Seroquel |
| Contraindications | Should not be taken if you are taking or have been taking monoamine oxidase (MAO) inhibitors. Risk of exacerbating symptoms of depression or increasing suicidal ideation. | Should not be taken if you are taking or have been taking monoamine oxidase (MAO) inhibitors. Risk of exacerbating symptoms of depression or increasing suicidal ideation. |
| Cost | For the generic version, prices start at just under ten cents ($0.10)/day and not exceeding around fifty cents ($0.50)/day at higher doses. | For the generic version, approximate costs from as low as $0.13 per day up to about $2.50 per day at typical dosages between 200mg - 800mg. |
| Generic Name | Mirtazapine | Quetiapine |
| Most Serious Side Effect | Heightened thoughts about suicide or self-harm, severe allergic reactions, severe skin reactions, visual changes, cardiovascular issues, lowered sodium levels, violent nervous system response, signs of serotonin syndrome. | Signs of an allergic reaction or a serious skin response, intensified suicidal thoughts or tendencies towards self-harm, seizures, disorientation, remarkable shifts in mood or behavior, distorted vision, rapid heart rate, symptoms indicative of a manic episode. |
| Severe Drug Interactions | MAO inhibitors, certain antibiotics and antifungals, HIV protease inhibitors, anti-seizure drugs. | MAO inhibitors, certain antibiotics and antifungals, HIV protease inhibitors, anti-seizure drugs. |
| Typical Dose | Begins at 15 mg/day, can be increased to a maximum of 45 mg/day. | Begins with a dosage of 25 mg/day, can be increased to 300-400 mg/day, with a maximum dose typically 800 mg/day. |
What is Remeron?
Mirtazapine (the generic name for Remeron) is a drug of the atypical antidepressants class. It was initially approved by the FDA in 1996 and has since been used to treat various forms of depression. Mirtazapine works by increasing levels of certain neurotransmitters, particularly serotonin and norepinephrine, in the brain to help maintain mental balance. Unlike other antidepressants that primarily influence serotonin, mirtazapine also affects noradrenaline, which can result in fewer side effects.
On the other hand, Quetiapine (the generic name for Seroquel) is an atypical antipsychotic first approved by the FDA in 1997. It's often prescribed for bipolar disorder and schizophrenia but may be used off-label for major depressive disorder as well. Seroquel influences several neurotransmitters including dopamine, serotonin, histamine H1 receptors and adrenergic α1- and α2-receptors resulting in a wider range of effects –and potentially more side effects– than mirtazapine.
What conditions is Remeron approved to treat?
Remeron is approved for the treatment of various mental health disorders, which include:
- Major depressive disorder (MDD)
- Insomnia due to its sedative effects
- Anxiety disorders due to its anxiolytic properties
On the other hand, Seroquel is indicated for:
- Treatment of schizophrenia
- Acute manic episodes associated with bipolar I disorder
- Bipolar II disorder as a mood stabilizer
How does Remeron help with these illnesses?
Remeron, also known as mirtazapine, works to manage depression by increasing the availability of serotonin and norepinephrine in the brain's synapses. It does this by acting on specific presynaptic receptors which inhibit the release of these neurotransmitters and block their reabsorption, thereby elevating their levels for longer periods. Both serotonin and norepinephrine are neurotransmitters that play crucial roles in mood regulation, sleep patterns, cognition and appetite among other bodily functions. Lower levels of these neurotransmitters have been associated with depressive states. Hence, by boosting serotonin and norepinephrine concentrations in the brain synapses, Remeron can help alleviate depressive symptoms and stabilize mood swings for patients managing depression.
What is Seroquel?
Seroquel, the brand name for quetiapine, is an atypical antipsychotic medication that works by modulating neurotransmitters in the brain such as serotonin and dopamine. It accomplishes this by blocking or lessening their effects which can help to balance out mood and perception. Seroquel was first approved by the FDA in 1997.
Unlike Remeron (mirtazapine), which primarily targets specific types of serotonin receptors and noradrenaline receptors, Seroquel has a broader action profile affecting multiple types of dopamine as well as serotonin receptors. This means its side-effect profile is different from that of traditional antidepressants like mirtazapine; it typically causes sedation (which can be beneficial for individuals with insomnia) but may also lead to weight gain and metabolic changes.
Furthermore, Seroquel's impact on both dopamine and serotonin makes it useful for treating conditions beyond depression, such as bipolar disorder or schizophrenia where patients might not respond well to "typical" antidepressant drugs like Remeron.
What conditions is Seroquel approved to treat?
Seroquel, also known by its generic name quetiapine, is an antipsychotic medication approved for the treatment of:
- Schizophrenia
- Bipolar disorder
- Major depressive disorder as an add-on treatment when other treatments have not worked sufficiently.
How does Seroquel help with these illnesses?
Quetiapine, commonly known as Seroquel, is an atypical antipsychotic that works by modulating several neurotransmitters in the brain including dopamine and serotonin. It has a broad spectrum of action with its effect on various receptor sites in the brain which helps to alleviate symptoms of bipolar disorder, schizophrenia and depressive disorders. Unlike Remeron (Mirtazapine), Seroquel also affects glutamate levels, another important neurotransmitter involved in mood regulation. This unique mechanism can be beneficial for those patients who have not responded well to typical antidepressants or other treatment modalities. The wide range of effects produced by Seroquel allows it to be used alone or combined with other medications depending upon patient’s response and tolerance.
How effective are both Remeron and Seroquel?
Both mirtazapine (Remeron) and quetiapine (Seroquel) have established histories in treating patients with depression, anxiety disorders, and insomnia. Mirtazapine was first approved by the FDA for use as an antidepressant in 1996, while quetiapine initially received approval as an antipsychotic for schizophrenia treatment in 1997. As they act on different neurotransmitters and receptors, their uses can vary depending on the patient's specific needs.
Mirtazapine is predominantly used to treat depressive disorder but has also shown efficacy in managing sleep disorders due to its strong antagonistic effect on histamine H1 receptors. A review of double-blind randomized controlled trials comparing mirtazapine to placebo or other antidepressants found it equally effective at reducing symptoms of depression with a unique side-effect profile including sedation, weight gain, and dry mouth.
Quetiapine is primarily classified as an atypical antipsychotic but is frequently used off-label for treating insomnia because of its sedative properties associated with histamine receptor antagonism. It exhibits a broader activity spectrum by blocking multiple dopamine and serotonin receptors which may contribute to its effectiveness against bipolar depression noted in several clinical trials from 2005 through 2010. However, quetiapine may lead to more serious side effects such as metabolic syndrome components like increased cholesterol levels or hyperglycemia.
A comprehensive meta-analysis published in 2018 indicated that both mirtazapine and low-dose quetiapine are viable options for major depressive disorder when SSRIs or SNRIs have failed or are not tolerated well due to their side-effects profiles differing from those classes of drugs. Additional research regarding long-term safety profiles especially concerning metabolic parameters during chronic administration should be considered when prescribing these medications.
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At what dose is Remeron typically prescribed?
Oral dosages of Remeron (mirtazapine) usually begin at 15 mg/day, and studies have shown that this is typically an effective dose for treating major depressive disorder in many individuals. However, if necessary, the dosage can be gradually increased to a maximum of 45 mg/day over several weeks based on patient response and tolerance. On the other hand, Seroquel (quetiapine) treatment often starts with a lower dosage such as 25-50 mg/day for adults which may then be increased based on individual need and tolerance. For most indications, the maximum recommended dose is 800 mg/day. It's important to note that these medications should always be used under medical supervision.
At what dose is Seroquel typically prescribed?
Seroquel treatment usually begins with a dosage of 25 mg/day. The dose can then be incrementally increased to 300-400 mg/day, divided into two doses, spaced about 12 hours apart. The maximum dose is typically 800 mg/day divided into two equal doses of 400 mg and spaced roughly 12 hours apart. This level may be considered if there is no response or insufficient response to treatment at the lower dosages after several weeks. It's important to remember that any changes in medication regimen should always be done under the supervision of a healthcare provider.
What are the most common side effects for Remeron?
Common side effects of Remeron may include:
- Drowsiness/somnolence
- Weight gain and increased appetite
- Dry mouth
- Constipation
- Increased cholesterol levels
On the other hand, Seroquel can cause:
- Sedation (drowsiness, sleepiness)
- Lowered blood pressure when changing positions (orthostatic hypotension)
- Dizziness or lightheadedness
- Dry mouth
- Upset stomach/indigestion/dyspepsia -Nasal congestion or stuffy nose (sinusitis)
Other significant side effects might occur with both medications, so it's crucial to discuss all potential risks and benefits with your healthcare provider.
Are there any potential serious side effects for Remeron?
While both Remeron and Seroquel are generally considered safe for use, they can occasionally lead to severe side effects in rare cases. These may include:
- Heightened thoughts about suicide or self-harm
- Signs of a serious allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue, or throat
- Severe skin reactions featuring symptoms like fever, sore throat, burning eyes, skin pain followed by a red or purple rash that spreads leading to blistering and peeling
- Visual changes including blurred vision and tunnel vision; eye discomfort or swelling; seeing halos around lights
- Cardiovascular issues characterized by rapid heart rate or pounding heartbeats; fluttering sensations in your chest; shortness of breath resulting into sudden dizziness (feeling as though you might faint)
- Lowered sodium levels triggering headaches confusion slurred speech intense weakness vomiting lack of coordination unsteady feeling -Violent nervous system response with very stiff (rigid) muscles high fever sweating confusion irregular fast heartbeats tremors feeling like you could pass out -Signs of serotonin syndrome: heightened agitation hallucinations increased body temperature sweating shivering faster than normal heartbeat muscle stiffness twitching loss of coordination nausea vomiting diarrhoea.
Remember always consult your healthcare provider if any unusual symptoms occur while using either medication.
What are the most common side effects for Seroquel?
With Seroquel, you may experience the following side effects:
- Dry mouth
- Constipation or upset stomach
- Blurred vision or dizziness
- Weight gain and increased appetite
- Feeling of restlessness and nervousness
- Difficulty sleeping (insomnia)
- Increased heart rate
- Headaches, muscle pain or weakness
- Frequent urination
It's also important to note that some people might experience agitation, confusion, hostile behavior but these are less common. Always consult your healthcare provider if any of these symptoms persist.
Are there any potential serious side effects for Seroquel?
While Seroquel is generally well tolerated, there are instances where it can cause severe side effects. In such cases, you may experience:
- Signs of an allergic reaction or a serious skin response: hives; itching; fever; swollen glands; difficulty breathing or swallowing due to swelling in the face, mouth or throat; burning sensation in the eyes; skin discomfort and redness turning into a purple rash that blisters and peels.
- Intensified suicidal thoughts or tendencies towards self-harm
- Seizures (convulsions)
- Disorientation, remarkable shifts in mood or behavior
- Distorted vision including tunnel vision, eye pain or swelling, seeing halos around lights
- Rapid heart rate
- Symptoms indicative of a manic episode: rapid thought process beyond the norm for you, heightened energy levels leading to risky actions having feelings of extreme happiness followed by irritability periods of excessive talking beyond your normal patterns and significant sleep disturbances.
If any of these symptoms occur while taking Seroquel discontinue use immediately and consult with your healthcare provider as soon as possible.
Contraindications for Remeron and Seroquel?
Both Remeron and Seroquel, like most other psychiatric medications, may exacerbate symptoms of depression in some individuals. If you notice your depression worsening or an increase in suicidal ideation, thoughts or behavior while taking these medications, please seek immediate medical help.
Neither Remeron nor Seroquel should be taken if you are taking or have been taking monoamine oxidase (MAO) inhibitors. Always inform your physician about all the medications you're currently on; MAOIs will require a period of approximately two weeks to clear from your system to prevent harmful interactions with both Remeron and Seroquel.
Furthermore, these medicines may also interact with other drugs such as certain antibiotics and antifungals, HIV protease inhibitors, anti-seizure drugs among others. Hence it's crucial that healthcare providers have complete information regarding any concurrent medication use.
How much do Remeron and Seroquel cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Seroquel (100 mg) averages around $600, which works out to $20–40/day, depending on your dose.
- The price for 30 tablets of Remeron (15 mg) is about $250, working out to approximately $8.33/day.
Thus, if you are in the higher dosage range for Seroquel (i.e., 400 mg/day or higher), then brand-name Remeron is 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 of Seroquel (quetiapine) and Remeron (mirtazapine), costs are significantly lower:
- Quetiapine Fumarate (100 mg tablets) is available in packs from 15 capsules up to several hundred with approximate costs from as low as $0.13 per day if buying larger packs upfront and can go up to about $2.50 per day at typical dosages between 200mg - 800mg
- Mirtazapine comes in packets ranging from single digit quantities up to hundreds with prices starting at just under ten cents ($0.10)/day when purchasing larger quantities ahead and not exceeding around fifty cents ($0.50)/day even at higher doses like those upwards towards near its maximum recommended daily dose limit of ~45mg
Popularity of Remeron and Seroquel
Mirtazapine, in generic form as well as under the brand name Remeron, was estimated to have been prescribed to about 4.7 million people in the US in 2020. Mirtazapine accounted for just around 10% of atypical antidepressant prescriptions in the US. It is a unique antidepressant that works by antagonizing specific serotonin and norepinephrine receptors; it also has potent antihistaminergic effects which make it especially useful for those with insomnia related to their depression or anxiety disorders.
Quetiapine, including brand versions such as Seroquel, was prescribed to approximately 3.5 million people in the USA during the same period. In terms of overall mood stabilizer and atypical antipsychotic prescriptions (its primary uses), quetiapine accounts for roughly one quarter of total prescriptions within these classes – despite this broad use base, its utilization generally remained steady over recent years rather than increasing or decreasing substantially like some other medications.
Conclusion
Both Remeron (mirtazapine) and Seroquel (quetiapine) have a strong record of use for patients with depression, bipolar disorder, and sleep disorders. They are supported by many clinical studies indicating they can be more effective than placebo treatments. In certain cases, the two drugs may be used together under close supervision of a healthcare provider due to their differing mechanisms of action.
Remeron primarily acts on serotonin and norepinephrine receptors while Seroquel largely targets dopamine as well as serotonin receptors thus reducing symptoms associated with these disorders. Mirtazapine is often considered an initial treatment option for patients struggling with depression or sleep issues, whereas quetiapine would usually be used in combination with other medications or if first-line options were not successful.
Both drugs are available in generic form which represents significant cost savings especially for those who must pay out-of-pocket expenses. Both Remeron and Seroquel require an adjustment period meaning that effects might not become noticeable immediately.
The side effect profile is similar between both medications but each drug has unique characteristics: mirtazapine is less likely to cause extrapyramidal side effects compared to quetiapine but it can lead to weight gain more frequently. For both medications, patients should closely monitor their mood changes when starting therapy and seek immediate medical help if they notice any worsening depressive symptoms or begin experiencing suicidal thoughts.
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Refrences
- Croom, K. F., Perry, C. M., & Plosker, G. L. (2009, May). Mirtazapine. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200923050-00006
- Nutt, D. J. (2002). Tolerability and safety aspects of mirtazapine. Human Psychopharmacology: Clinical and Experimental. Wiley.http://doi.org/10.1002/hup.388
- Sanford, M., & Keating, G. M. (2012, May). Quetiapine. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/11203840-000000000-00000
- Kondo, M. A., Tajinda, K., Colantuoni, C., Hiyama, H., Seshadri, S., Huang, B., … Sawa, A. (2013, April 2). Unique pharmacological actions of atypical neuroleptic quetiapine: possible role in cell cycle/fate control. Translational Psychiatry. Springer Science and Business Media LLC.http://doi.org/10.1038/tp.2013.19
- Wetzel, H., Szegedi, A., Hain, C., Wiesner, J., Schlegel, S., & Benkert, O. (1995, May). Seroquel (ICI 204 636), a putative “atypical” antipsychotic, in schizophrenia with positive symptomatology: results of an open clinical trial and changes of neuroendocrinological and EEG parameters. Psychopharmacology. Springer Science and Business Media LLC.http://doi.org/10.1007/bf02246165