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Remeron vs Trazodone
Introduction
For patients with major depressive disorder (MDD) or other types of depression, certain drugs that alter the concentrations of compounds in the brain known as neurotransmitters can help stabilize depressive lows and manage symptoms. Remeron and Trazodone are two such medications often prescribed for depression. They each impact different neurotransmitters in the brain but both have mood-stabilizing effects on patients suffering from depression.
Remeron, also known as mirtazapine, boosts norepinephrine and serotonin levels by blocking specific adrenergic receptors and acting as an antagonist at some subtypes of serotonin receptors. On the other hand, Trazodone is a serotonin antagonist/reuptake inhibitor (SARI), primarily increasing levels of serotonin by inhibiting its reuptake into neurons while also blocking certain serotonergic receptors thereby boosting its availability in the brain's synapses.
Remeron vs Trazodone Side By Side
| Attribute | Remeron | Trazodone |
|---|---|---|
| Brand Name | Remeron | Trazodone |
| Contraindications | Should not be taken with or shortly after taking monoamine oxidase (MAO) inhibitors. | Should not be taken with or shortly after taking monoamine oxidase (MAO) inhibitors. |
| Cost | For brand name: around $230 for 30 tablets (30 mg). For generic: $.10 to $.50 per day depending on quantity and strength. | For brand name: about $60 for 20 tablets (150 mg). For generic: $.04 to $.75 per day depending on quantity. |
| Generic Name | Mirtazapine | Trazodone |
| Most Serious Side Effect | Thoughts of suicide or self-harm, severe skin reactions, vision disturbances, cardiovascular symptoms, symptoms indicative of low sodium levels, severe nervous system reactions. | Allergic responses, suicidal thoughts or mood changes, chest pain, trouble breathing, fast/irregular heartbeat, feeling faint or lightheaded, changes in vision, unusual bleeding or bruising, extreme levels of restlessness or agitation. |
| Severe Drug Interactions | Monoamine oxidase (MAO) inhibitors. | Monoamine oxidase (MAO) inhibitors. |
| Typical Dose | Starts from 15 mg/day up to a maximum of 45 mg/day. | Starts at 150 mg/day, can be increased by 50 mg every three to four days. Maximum daily dose is 400 mg for outpatients, up to 600 mg for hospitalized patients. |
What is Remeron?
Mirtazapine (the generic name for Remeron) is a unique type of antidepressant known as a noradrenergic and specific serotonergic antidepressant (NaSSA). It was approved by the FDA in 1996. Remeron enhances levels of norepinephrine and serotonin in the brain by blocking receptors that would otherwise absorb these neurotransmitters, thereby increasing their availability. This drug is primarily prescribed to treat major depressive disorder. Mirtazapine has a selective influence on certain types of serotonin receptors while boosting norepinephrine, which results in it having fewer gastrointestinal side effects than other antidepressants with broader impacts on these systems.
On the other hand, Trazodone also increases levels of serotonin but does so through inhibiting its reuptake and altering the response of certain nerve cells to this neurotransmitter. Additionally, unlike mirtazapine, trazodone's effect isn't limited only to specific serotonin receptor subtypes; therefore it may present more side effects related to overstimulation of various kinds of serotonin receptors.
What conditions is Remeron approved to treat?
Remeron is approved for the treatment of the following mental health disorders:
- Major depressive disorder (MDD), often referred to as unipolar depression
- Anxiety disorders, including generalized anxiety disorder and social anxiety disorder
- Insomnia, particularly when associated with depression or anxiety In contrast, Trazodone is primarily used off-label for insomnia but also has FDA approval for treating major depressive disorder.
How does Remeron help with these illnesses?
Remeron helps to manage depression by increasing the amount of norepinephrine and serotonin available in the synapses of the brain. It does this by inhibiting their reuptake, meaning it blocks them from being absorbed back into nerve cells in the brain. This results in prolonged neurotransmitter activity at synapse levels, which can elevate mood over time. Norepinephrine, also known as noradrenaline, is a chemical that acts as both a hormone and neurotransmitter; it plays an important role in attention, responses to stress and memory storage amongst other things. Serotonin similarly functions as a neurotransmitter with key roles in mood regulation, sleep patterns, appetite and body temperature regulation among others. It's theorized that individuals with depression may have relatively lower levels of these two chemicals within certain areas of their brains. Therefore, by increasing norepinephrine and serotonin availability through reuptake inhibition via Remeron use can potentially mitigate depressive symptoms whilst aiding patients towards managing their condition more efficiently.
What is Trazodone?
Trazodone, sold under many brand names worldwide, is an antidepressant of the serotonin antagonist and reuptake inhibitor (SARI) class. This means it increases levels of serotonin in the brain by reducing its absorption into neurons. It also prevents serotonin's action at certain postsynaptic receptors. Trazodone was first approved by the FDA in 1981.
Unlike Remeron (mirtazapine), which is a noradrenergic and specific serotonergic antidepressant (NaSSA), trazodone does not enhance norepinephrine release or block muscarinic acetylcholine receptors. Its unique mode of action on serotonin means that its side-effect profile differs from that of NaSSAs like Remeron - for instance, it may cause less weight gain and sedation but can lead to other side effects such as nausea or dizziness.
The effects on serotonin can be beneficial for treating depression, particularly in patients who do not respond well to traditional SSRI drugs or NaSSAs like mirtazapine.
What conditions is Trazodone approved to treat?
Trazodone is approved for the treatment of various conditions including:
- Major depressive disorder (MDD), a condition characterized by persistent feelings of sadness, loss of interest in activities, and other emotional and physical symptoms.
- Insomnia associated with depression. It's used as a second-line treatment when other treatments are not effective or cannot be used.
How does Trazodone help with these illnesses?
Serotonin is a neurotransmitter that plays significant roles in various body processes, affecting mood regulation, sleep patterns and appetite. Low levels of serotonin have been linked to conditions such as depression. Trazodone operates by increasing the levels of serotonin available in the brain, thus helping alleviate some symptoms associated with depressive disorders. Its action on other neurotransmitters like norepinephrine may also play several roles in its activity as an antidepressant. Since it does not significantly affect dopamine levels, trazodone is often prescribed when a patient doesn't respond well to typical SSRIs or atypical antidepressants (such as Remeron), or it may be used in combination with these drugs.
How effective are both Remeron and Trazodone?
Both mirtazapine (Remeron) and trazodone have proven histories of success in treating patients with depression and were initially approved by the FDA a few years apart. Since they act on different neurotransmitters, they may be prescribed under different circumstances. The effectiveness of mirtazapine and trazodone in alleviating depression was directly studied in a double-blind clinical trial; the two drugs exhibited similar efficacy levels in managing symptoms of depression as well as comparable safety profiles. In this study, none of the various metrics used to measure efficacy in treating depression showed significant differences between patients receiving mirtazapine or those taking trazodone.
A review demonstrated that mirtazapine is effective at alleviating symptoms of major depressive disorder from the first week of treatment, its side effect profile is comparably favorable to many other antidepressants, and it is well-tolerated across varied populations including elderly individuals. Mirtazapine has been widely-prescribed worldwide due to its dual mechanism action that promotes both noradrenergic and specific serotonergic transmission.
On the other hand, studies indicate that trazodone seems to be more effective than placebo for treating insomnia associated with mood disorders while providing an added benefit against depressive symptoms. Nonetheless, trazodone's use often follows unsuccessful treatments with SSRIs or other first-line interventions due to its sedative effects which can interfere with daytime functioning if not managed properly. Most research involves using low-dose trazodone as add-on therapy alongside another antidepressant for cases where sleep disturbance remains problematic despite adequate treatment for mood symptoms.
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At what dose is Remeron typically prescribed?
Oral dosages of Remeron (Mirtazapine) typically start from 15 mg/day and can be increased to a maximum dose of 45 mg/day, based on how the patient responds. It's worth noting that some patients have shown significant improvement with just 15 mg/day. On the other hand, Trazodone dosage usually starts at 150 mg/day divided into smaller doses throughout the day or taken as one single dose before bedtime. The dosage may be gradually increased by your doctor up to a maximum daily dose of around 400mg for outpatients and even higher for hospitalized patients under medical supervision. Please keep in mind these are general guidelines; always follow your healthcare provider's instructions regarding medication dosage and frequency.
At what dose is Trazodone typically prescribed?
Trazodone therapy typically begins with a dosage of 150 mg/day, which can be taken as a single dose or divided into two doses. If necessary, the dosage may then be increased by increments of 50 mg every three to four days. The maximum daily dose is commonly set at 400 mg for outpatients and up to 600 mg in hospitalized patients, both split into two separate doses. For those not responding well to this regimen after several weeks, healthcare providers might consider increasing the dosage even further—although this should only take place under close medical supervision due to possible side effects.
What are the most common side effects for Remeron?
Common side effects of Remeron (Mirtazapine) and Trazodone can include:
- Somnolence (sleepiness/drowsiness)
- Increased appetite
- Weight gain
- Dizziness
- Dry mouth
- Constipation
- Elevated cholesterol levels
- Fatigue, asthenia (general weakness and fatigue)
- Edema (swelling caused by excess fluid in your body's tissues)
Less common but more serious side effects may include:
- Decreased libido or sexual ability.
- Abnormal thinking, behavioral changes or suicidal thoughts.
- Serotonin syndrome symptoms like agitation, hallucinations, rapid heartbeat.
Remember to consult with your healthcare provider if you experience these or any other unexpected side effects.
Are there any potential serious side effects for Remeron?
In rare instances, Remeron may lead to serious side effects such as:
- Thoughts of suicide or self-harm
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Severe skin reactions: fever, sore throat, burning eyes, skin pain accompanied by a red or purple rash that spreads and causes blistering and peeling
- Vision disturbances like blurred vision, eye pain or swelling
- Cardiovascular symptoms like fast heartbeats, chest fluttering sensations, shortness of breath and sudden dizziness
- Symptoms indicative of low sodium levels include headaches, confusion speech difficulties (including slurred words), pronounced weakness that can lead to vomiting and loss of coordination which might make you feel unsteady.
Additionally there could be severe nervous system reactions with very stiff muscles causing high fever along with sweating. These could also manifest as unexpected changes in heartbeat patterns including faster rates alongside body tremors potentially making you feel faint.
If you experience any symptoms associated with serotonin syndrome such as agitation hallucinations fever excessive sweating shivering muscle stiffness twitching loss of coordination nausea vomiting diarrhea it is best to consult your healthcare provider immediately.
What are the most common side effects for Trazodone?
Trazodone, as an alternative to Remeron, can present a range of side effects which may include:
- Dry mouth or altered taste sensation
- Mild headache or dizziness
- Feeling nervous or anxious
- Constipation, upset stomach, vomiting
- Weight changes (loss/gain)
- Blurred vision and ringing in the ears
- Sleep disturbances such as insomnia or excessive sleepiness
- Muscle pain
- Rash or itching skin -Frequent urination and/or urinary retention.
It's important to note that while Trazodone is generally well-tolerated by most people, if any of these side effects persist or become bothersome, it would be advisable to consult with your healthcare provider.
Are there any potential serious side effects for Trazodone?
While Trazodone is generally well-tolerated, it's important to stay alert for any potential adverse reactions. Watch out for the following signs:
- Allergic responses such as skin rash, itching or hives; swelling of the face, lips or tongue
- Suicidal thoughts or other mood changes
- Chest pain, trouble breathing or fast/irregular heartbeat
- Feeling faint or lightheaded
- Changes in vision including blurred vision and seeing halos around lights
- Unusual bleeding or bruising
- Extreme levels of restlessness, agitation, mania (feeling unusually excited), anxiety, panic attacks
If you experience any of these symptoms after taking trazodone, seek immediate medical attention.
Contraindications for Remeron and Trazodone?
Both Remeron and Trazodone, along with most other antidepressant medications, may intensify symptoms of depression in some individuals. If you observe your depression escalating or an increase in suicidal thoughts or behaviors, it's crucial to seek immediate medical attention.
Neither Remeron nor Trazodone should be taken if you are currently taking, or have recently stopped taking monoamine oxidase (MAO) inhibitors. Always inform your doctor about any medications you're using; MAOIs will need roughly 5 weeks to clear from the system in order to avoid potentially dangerous interactions with Remeron and Trazodone.
How much do Remeron and Trazodone cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Remeron (30 mg) averages around $230, which works out to approximately $7.67/day.
- The price of 20 tablets of Trazodone (150 mg) is about $60, working out to roughly $3/day.
Thus, if you are taking the typical dosage for each drug, then the brand-name version of Trazodone is less expensive on a per-day treatment basis compared to Remeron. However, remember that cost should not be your only consideration when determining which medication is most suitable for you.
For the generic versions:
- Mirtazapine (generic name for Remeron), available in packs from 7 up to 100 tablets (15 or 30 mg), costs between $.10 and $.50 per day depending on tablet strength and quantity purchased.
- Generic Trazodone can be bought in packs ranging from 20 up to several hundred at a time with prices starting as low as $.04/day (for larger purchases) but typically running between $.15 and $.75 per day.
Popularity of Remeron and Trazodone
Mirtazapine, available in generic form and under the brand name Remeron, was estimated to have been prescribed to approximately 1.3 million people in the US in 2020. Accounting for nearly 2.8% of all antidepressant prescriptions within that year, mirtazapine is commonly used as an "atypical" antidepressant - not classified as an SSRI or other broad class of antidepressants.
On comparison, Trazodone was prescribed to more than 4.4 million individuals in the United States throughout the same period. This accounts for roughly 9% of all overall antidepressant prescriptions in the country. Much like mirtazapine, trazodone also falls into this “atypical” category but has a significantly higher prescription rate due to its double action as a sleep aid alongside being an effective treatment for depression.
Conclusion
Both Remeron (mirtazapine) and Trazodone are widely used in the treatment of depression, with a wealth of clinical studies demonstrating their effectiveness over placebos. In certain cases, these two drugs may be combined, but this requires careful monitoring by a healthcare professional due to potential drug-drug interactions. They have different mechanisms of action: Remeron largely exerts its antidepressant effects by enhancing both norepinephrine and serotonin neurotransmission, while Trazodone primarily works by inhibiting serotonin uptake.
Remeron is often favored for patients who also experience insomnia or significant weight loss related to their depression because it tends to cause sleepiness and increase appetite. On the other hand, Trazodone is frequently chosen as an adjunct therapy for those not responding adequately to first-line antidepressants or those needing help with sleep issues.
Both medications are available in generic form which can lead to considerable cost savings for patients paying out-of-pocket. As with many psychiatric medicines, there may be an adjustment period where the full therapeutic effect isn't immediately noticeable.
In terms of side effects profile, both drugs are generally well tolerated but carry slightly different risks; drowsiness being common in both whereas Remeron may cause increased appetite and weight gain. It's vital that patients monitor their mood closely when starting either medication and seek medical attention right away if they notice any worsening depression symptoms or emerging suicidal thoughts.
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Refrences
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