11 Effective Alternatives to Mirtazapine

Mirtazapine (also known by the brand name, Remeron) is an antidepressant in the class of drugs called atypical tetracyclic antidepressants. The prescription medication is approved to treat major depressive disorder (MDD) and is also used off-label for conditions like anxiety, OCD, PTSD, and insomnia. Despite being known for its efficacy, some people want an alternative to mirtazapine​. This can be due to side effects, cost, lack of effectiveness, or a simple personal preference for a more holistic, non-pharmaceutical approach.

If you’re looking for alternatives to mirtazapine for depression, anxiety, or another mental health condition, it’s important to remember that you have many options. Work with your doctor or a mental health professional before you change your medication or stop taking a drug.

Alternative Medications to Mirtazapine

There are several other drug options to choose from if you’re looking for a mirtazapine alternative. The drugs below can be just as effective in managing symptoms that mirtazapine treats. 

Sertraline (Zoloft)

Sertraline (brand name Zoloft) is an antidepressant medicine in the class of drugs called selective serotonin reuptake inhibitors (SSRIs). It’s commonly prescribed to treat depression and anxiety disorders. A sertraline prescription differs from mirtazapine because it’s much less sedating, so it might be more suitable for someone who wants to avoid drowsiness.

Common side effects of Zoloft can include: 

• Nausea
• Insomnia
• Diarrhea 
• Dry mouth
• Feeling tired or weak
• Sexual dysfunction

Note that many side effects linked to sertraline often diminish over time.

Fluoxetine (Prozac)

Fluoxetine is another SSRI that’s widely prescribed to treat depression, anxiety, and obsessive-compulsive disorder (OCD). Its long half-life reduces the risk of withdrawal symptoms upon discontinuation, making Prozac prescriptions a popular choice for anyone worried about having difficulty coming off a drug. Fluoxetine has a stimulating effect, which can be ideal for people with low energy (which is common with depression). 

Common side effects of Prozac can include: 

• Headache
• Difficulty sleeping
• Nausea
• Diarrhea
• Feeling weak or tired
• Sexual dysfunction 

Escitalopram (Lexapro)

Escitalopram (brand name Lexapro) is a well-tolerated SSRI medicine known for its efficacy in treating depression and generalized anxiety disorder (GAD). This drug also has fewer side effects compared to some other, older SSRIs, which is why a Lexapro prescription is often considered a first-line treatment.

Common side effects of Lexapro can include: 

• Headache
• Nausea
• Dry mouth
• Excess sweating
• Sleep disturbances
• Feeling weak or tired

Duloxetine (Cymbalta)

Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI). It can be prescribed to treat depression as well as some chronic pain conditions, like neuropathy or fibromyalgia. Because of its dual action, a Cymbalta prescription is often used when people have comorbid pain symptoms. 

Common side effects of Cymbalta can include: 

• Insomnia
• Dizziness
• Constipation
• Headache
• Fatigue

Venlafaxine (Effexor XR)

Venlafaxine (Effexor XR) is yet another SNRI. It helps manage symptoms of depression and some anxiety disorders. Venlafaxine is an extended-release formula that offers constant, long-lasting relief throughout the day.

Common side effects of venlafaxine can include: 

• Sweating
• Drowsiness
• Seizures
• Constipation
• Headache
• Sexual dysfunction

Note that venlafaxine can cause high blood pressure when used in high doses.

Trazodone

Trazodone is in a different class of drugs known as serotonin receptor antagonists and reuptake inhibitors (SARIs). These work by balancing levels of serotonin in the brain. Trazodone is used to treat depression, anxiety, and insomnia. When this medicine is prescribed at a low dose, its sedative effects can promote sleep. To treat depression though, it’s generally prescribed at a higher dose or as an adjunct medication. 

Common side effects of trazodone can include: 

• Feeling sleepy
• Headaches
• Nausea
• Dry mouth
• Constipation
• Blurred vision 
• Change in sex drive

Amitriptyline

Amitriptyline is a tricyclic antidepressant that can treat depression or be used off-label as a mirtazapine alternative for sleep and chronic pain management — like migraines and neuropathic pain.

Common side effects of Amitriptyline can include: 

• Constipation
• Dizziness
• Feeling sleepy
• Difficulty urinating
• Dry mouth
• Headache

“Common alternatives to Mirtazapine for the treatment of anxiety and depression include Escitalopram and Fluoxetine. Trazodone is a common alternative used for sleep. Trazodone is especially used for patients who desire improved sleep without Mirtazapine’s possible side effect of weight gain.”

– Talkspace therapist Dr. Dion Metzger, MD

Natural/Non-Pharmaceutical Alternatives to Mirtazapine

Some people want a more natural or non-pharmaceutical alternative to mirtazapine. Fortunately, there are options available that may help treat depression, anxiety, and insomnia without using prescription drugs — and for many, they can be very effective. 

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a structured form of therapy. It helps you identify and change unhealthy, negative thoughts and behavior patterns that might be contributing to mental health challenges. CBT techniques can be as or more effective than medication when treating conditions like depression and anxiety. 

CBT can be conducted in a one-on-one or group setting, and it typically involves weekly sessions that occur over several months.

Mindfulness-based stress reduction (MBSR)

Mindfulness-based stress reduction (MBSR) combines the power of mindfulness meditation with yoga to reduce stress and enhance emotional and psychological well-being. Research shows that MBSR is effective in reducing anxiety, depression, and stress.

Physical lifestyle changes

Fundamental, easy-to-implement physical changes — like regular exercise, eating well, and staying physically active — can improve mood and sleep quality. Commit to working out, like walking, swimming, or cycling. Even just 30 minutes of exercise a day can drastically reduce symptoms of anxiety and depression. Maintaining a healthy sleep routine and creating a restful sleep environment can also improve insomnia.

Nutritional support and supplements

Natural supplements have become increasingly popular in recent years. These non-pharmaceutical options that may help treat mental health are options for people who want to try a holistic approach to their mental well-being. 

• Omega-3 fatty acids: Fish oil contains omega-3 fatty acids, which have been linked to improved mood and cognitive function.
• Vitamin D: Research suggests that vitamin D deficiency is associated with depression and anxiety. Thus, supplements might be beneficial for some people. 
• St. John’s Wort: An herbal remedy that some studies suggest can be effective for mild to moderate depression. However, it can interact with various medications, so it’s crucial to consult a healthcare provider before using it. More research is still needed on this natural alternative to mirtazapine, but current data is promising. 
• Chamomile: Some herbal supplements promote relaxation. Chamomile was shown to improve sleep and reduce anxiety.

It’s essential that you approach natural supplementation carefully — natural doesn’t always mean safe. Talk to your doctor about anything you’re considering trying before you make the switch. Some holistic supplements can interact with other medications, and side effects are possible, so you should tell your doctor what you want to try so they can monitor you.

Considerations When Choosing a Mirtazapine Alternative

When choosing a mirtazapine alternative, certain factors — like your health background, how well you tolerate side effects, the cost of medicine, and your lifestyle — will all play a role in determining what medication might be the best option for your needs. Your doctor can help you decide on the right alternative treatments while ensuring your safety.

When selecting an alternative to Mirtazapine, consider personal factors like:

• Health history: Pre-existing and current medical conditions as well as certain medications can impact which alternative treatment might be best for you.
• Side effect tolerability: Your sensitivity to potential side effects can help guide your decision between medications or non-pharmaceutical options.
• Cost: Financial considerations, including insurance coverage and out-of-pocket expenses, can also impact treatment decisions.
• Lifestyle: Personal preferences, habits, and routines can affect how well you adhere to a treatment plan.  

When you consult with a healthcare provider about making changes to your treatment plan, they can provide you with personalized recommendations and monitor your reactions and progress. They’ll also be able to adjust things like dose or medication to ensure you’re safe and getting the best outcomes possible. 

Find the Right Alternative with Talkspace

Choosing the right alternative to mirtazapine is easier when you take a personalized approach that’s guided by a trained, experienced mental health professional. Talkspace offers online psychiatry services that make getting help convenient. With Talkspace, you’ll have access to licensed professionals who can help you with therapy, medication management, and guidance to alternatives if you want to go on a different path. 

Connect with an online psychiatrist today to learn more about how to get a mirtazapine prescription or explore alternative non-pharmaceutical options.