Should I Try Mirtazapine for My OCD Symptoms?

You have been struggling with OCD for a while. Cognitive-behavioral therapy (CBT), exposure-response and prevention (ERP) therapy (the go-to treatment for OCD), and acceptance and commitment therapy (ACT) have been unsuccessful, so your OCD therapist recently added medication, specifically Prozac, an SSRI antidepressant, to your treatment plan. SSRIs, also clinically known as selective serotonin reuptake inhibitors, are designed to boost your serotonin levels. This is important because OCD sufferers are known to suffer from low serotonin levels or a serotonin deficiency.

Serotonin is considered both a neurotransmitter (chemical messenger in the brain) and the “happy hormone” because it helps balance your mood, ease stress, aid in quality sleep, and elicit joy in the body. So, adding an SSRI to the mix was supposed to be a “home run,” but it has not been. In fact, you have noticed very little change in your OCD symptoms after combining it with OCD therapies. You have also been partaking in natural remedies, alternative treatments, and self-help tools for OCD, and while they have helped some, you still need more.

You need that “magic pill” to help you get ahold of your rogue obsessions and compulsions, although you know that there is no cure-all pill for OCD. So, what is going on with you? Well, it sounds like you are dealing with treatment-resistant OCD. Treatment-resistant OCD is classified as OCD that does not respond to standard OCD treatments like CBT, ERP therapy, ACT, and/or SSRIs.

Although this “type” of OCD is challenging, it can still be successfully treated – with the right methods, tools, etc. Because Prozac did not yield the desired results, your doctor decided that mirtazapine, a tetracyclic “atypical” antidepressant, that increases both your serotonin and noradrenaline levels. The hope is this medication will help you finally get a hold of your OCD symptoms.

Will mirtazapine work for your OCD? Well, the jury is still out. It can take a month to really feel the effects of mirtazapine, so you will not know how successful this medication will be for your OCD, however, you have heard some good things about it, and as a result, have high hopes that you will finally become OCD-free.

If you are wondering if mirtazapine could work for your OCD, you have come to the right place, this article will share with you everything you need to know about the medication, so you can make the right treatment choice for your condition.

Let’s Talk About OCD

Obsessive-compulsive disorder (OCD) is a fairly common chronic anxiety condition characterized by upsetting, frightening, or intrusive thoughts, fears, doubt, worries, mental images, negative emotions, etc., that simply will not go away, regardless of what you do (or do not do), and/or relentless urges to repeat behaviors or actions so many times that it limits your ability to accomplish tasks, and affects your quality of life.

Some people suffer from pure-O (just obsessions), others suffer from just compulsions, and yet, the majority of OCD sufferers struggle with both obsessions and compulsions. Some common obsessions center on dirtiness, germs, and contamination, distressing thoughts of harm (oneself and/or others), a “fixation” on suicide, etc. OCD sufferers, who are obsessed with dirtiness, germs, and contamination may clean their homes, cars, and bodies 5x, 10x, 20x, etc. (basically until their stress and anxiety lessens or disappears).

These individuals may also refrain from having sex with their partners for fear of “catching” something (i.e., a sexually-transmitted disease (STD) from them, or transferring something to them. As a result, OCD sufferers with this “fixation” may turn to porn as a “libido booster,” to release sexual tension and experience sexual satisfaction.

People with OCD, who are obsessed with thoughts of harm, may refuse to leave their homes, drive their cars, visit with friends and loved ones, and/or beg partners, loved ones, and friends not to leave their homes or go places for fear that something terrible will happen if they do so.

 People, who suffer from harm OCD, also may socially isolate themselves from others and refuse to leave their homes out of fear of intentionally or unintentionally hurting themselves and others. The good news is that OCD can be successfully treated – the key is finding the right approach, techniques, and tools to make that happen.

The most common OCD treatments involve a combination of CBT, ACT, and ERP therapy, along with other therapies, such as individual, group, couples/marriage, addictions, and/or trauma therapies, like EDMR or TMS. Natural remedies, alternative/holistic treatments, and self-help tools are often added to prescribed OCD treatment plans.

These natural aids may include mindfulness meditation, CBD, healthy coping skills and strategies, lifestyle changes (i.e., a healthy diet, quality sleep, and lots of exercise), OCD support groups, forums, and podcasts, hypnotherapy/hypnosis, vitamin and mineral (magnesium) supplements, journaling, yoga, deep breathing, art therapy, music therapy, and an online OCD treatment program, like Impulse Therapy.

What Medicines Are Used to Treat OCD?

If therapy alone does not work, your OCD therapist may prescribe a medication, usually an SSRI, like Prozac, Zoloft, Lexapro, or Paxil to your treatment plan. A medication may be added to your OCD therapies to garner better results. However, sometimes SSRIs (the go-to medication for OCD) do not work either. Then, what? Well, an OCD therapist may switch you to another medication like an atypical antidepressant, like mirtazapine.

What is Mirtazapine?

Mirtazapine is an atypical antidepressant. Researchers are still unsure exactly how the medication works in the body. However, studies suggest that mirtazapine improves communication between the hormones/neurotransmitters, serotonin and norepinephrine.

More specifically, it appears to increase these levels, thereby, reducing intrusive thoughts, fears, urges, mental images, doubts (obsessions), and/or repetitive behaviors (compulsions). Keep in mind, however, that mirtazapine may alter your thinking patterns and/or responses, so do not try or operate machinery until you know how this medication affects you. Also, understand that drinking alcohol can increase the side effects of mirtazapine.

What is the Brand Name for Mirtazapine?

Mirtazapine is sold under the brand names – Remeron and Remeron SolTab.

What Forms Does Mirtazapine Come In?

Mirtazapine is offered in tablet form.

What Does Mirtazapine Treat?

Mirtazapine is FDA-approved for the treatment of major depressive disorder (MDD) or depression in adults. However, it is also sometimes used to treat (off-label) to treat a variety of anxiety conditions, like post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic use disorder and panic attacks, and OCD. Moreover, it may be used to treat other mood disorders, like bipolar disorder, seasonal affective disorder (SAD), etc.

Can Mirtazapine Be Used to Treat OCD?

Yes, it can!

Mirtazapine can be used for the treatment of obsessive-compulsive disorder (OCD). Studies suggest that this medication may be beneficial for OCD sufferers, who are struggling with treatment-resistant OCD, especially if they are also suffering from a comorbid condition of OCD and depression. Researchers have found that mirtazapine has helped many OCD sufferers successfully recover from the condition. Mirtazapine should not be given to children with OCD.

Is Mirtazapine Safe and Effective for OCD?

Yes, for the most part.

According to a 2005 study, some OCD sufferers may experience a significant improvement in their obsessions and compulsions after taking mirtazapine for their symptoms. Thus, researchers have concluded that mirtazapine is a safe and effective treatment for OCD in adults.

 Similarly, a 2022 clinical trial found that treatment-resistant OCD sufferers experienced the most significant reductions in OCD symptoms when mirtazapine was combined with sertraline.

Researchers concluded that combining mirtazapine and sertraline boosted the effects of the two medications, and as a result, aided in the treatment and management of OCD. Another 2009 study investigated the effects of mirtazapine for OCD and found that mirtazapine is not only a potent antidepressant but can also help combat OCD symptoms.

Researchers also found that mirtazapine works faster than SSRIs (the standard medications for OCD). Mirtazapine typically takes a couple of weeks to produce results (albeit mild ones for most OCD sufferers), whereas SSRIs can take up to 6 weeks to produce results. Many OCD sufferers experience a significant improvement in their OCD within 4 weeks.

A 2018 study suggests that combining mirtazapine and SSRIs could yield promising results. Keep in mind that everyone’s body chemistries are different, which means some OCD sufferers may be unable to tolerate mirtazapine, causing them to discontinue it in favor of another medication. And, refrain from self-medicating with mirtazapine because it could lead to life-threatening consequences.

What Do Mirtazapine OCD Users Say About the Medication?

I believe that the best way to get a real-life glimpse of how a medication, which in this case is mirtazapine, works for different individuals.

Therefore, listed below are a few reviews and testimonies of how mirtazapine is working or did work for them:

Ester

“I experienced mild depression as a child and as a teenager. But it always resolved itself with minimal effort. However, 6 years ago, I was misdiagnosed with depression and panic disorder. Since then, I have put on and had to be ‘weaned off’ five different antidepressants. After I moved, a new psychiatrist put me on mirtazapine, and WHOA! I finally feel like myself again. I no longer have back-to-back obsessions and compulsions. And, my stress, depression, and anxiety have subsided tremendously. My psychiatrist thinks my previous psychiatrist misdiagnosed me with just depression, when in actuality, my depression and anxiety, were caused by long-term, untreated OCD.”

Khan

“Every morning, I was gripped with severe OCD and anxiety. Once I started taking mirtazapine at night, I had much lower anxiety each morning. My OCD also got better. But after a few days, my body adapted to it, and its effects began to diminish. So, my doctor increased the dose from 15mg to 30mg, and then to 45mg. But each time, the effects would be good at first only to diminish or vanish later.

Moreover, mirtazapine causes me to have the most frightening, vivid, and weird dreams. I also experienced severe restless leg syndrome (RLS), along with an uncontrollable shakiness of my limbs while asleep. But as soon as I was tapered down, these side effects lessened. So, while I feel this medication may initially work for anxiety and OCD, I do not recommend it for longer use.”

Lucy

“I took mirtazapine to cope with depression, anxiety, and OCD regularly for a while. However, it made my conditions, including OCD, worse. I was using mirtazapine to avoid continuous intrusive thoughts and compulsive behaviors. This medication did not work for me, and on top of everything else, it started me on the path to substance abuse. It even made me suicidal while awake. For instance, once I took my morning dose of mirtazapine, went to class to take my mid-semester exam (I am a college student), and ended up passing out during the test.

I ended up failing my college courses that year, primarily because the drug was so horrible. It only worked for my sleep issues. Mirtazapine is definitely good for reducing or eliminating insomnia, nightmares, and night terrors. I am now in treatment for substance abuse. Because of the side effects, my doctor took me off of mirtazapine and put me on Zoloft, an SSRI antidepressant. If you have persistent, unwanted intrusive thoughts that prevent you from living, then I would not recommend mirtazapine for your OCD.”

What is the Recommended Mirtazapine Dosage For OCD?

Most psychiatrists typically start OCD sufferers off with 30mg, per day, to help them better manage their OCD symptoms. However, for some OCD sufferers, this is not enough. If 30mg of mirtazapine is ineffective, your doctor will likely boost your dosage up to 60mg, per day. However, keep in mind that body chemistries, ages, genders, health statuses, etc., vary, so the dosage will also vary. For instance, people with severe OCD may be prescribed a higher dose, while people with controlled OCD may be prescribed a lower one. Severe or treatment-resistant OCD is sometimes treated with a combo of mirtazapine and SSRIs.

How Should Mirtazapine Be Taken for OCD?

Listed below are tips on how mirtazapine should be taken for OCD:

• It is important to take mirtazapine for your OCD exactly as prescribed. In other words, follow the instructions on your prescription label. Also, read patient medication sheets. Keep in mind that your doctor may change your dose if he or she does not feel that it is working adequately. 
• Always take mirtazapine at the same time each day, preferably at bedtime.
• Take mirtazapine tablets with water, however, you can take this medication with or without food. 
• Only remove the dissolvable mirtazapine tablet from the pack when you are ready to take it. Place the tablet on your tongue, and allow it to dissolve without chewing or crushing it. Take several swallows as the tablet dissolves to ensure you are getting all of it.

How Long Does It Take for Mirtazapine to Work for OCD?

Some OCD sufferers may experience mild improvement 2 to 3 weeks after starting mirtazapine for OCD. Full results will probably not occur until about the 4th week of taking the medication.

Does Mirtazapine Have Any Side Effects?

Yes, it does.

Like almost all medications, mirtazapine comes with a host of side effects, such as:

Common Side Effects

• Xerostomia
• Constipation
• Drowsiness
• Dizziness
• Generalized Weakness
• Sudden Weight Gain
• Increased Appetite or Excessive Hunger
• Hypercholesterolemia
• Mental Confusion
• Mood Swings
• Anxiety
• Agitation
• Hyperkinesis
• Orthostatic Hypotension
• Chronic Back Pain
• Myalgia
• Vertigo
• Flu-like Symptoms
• Hypokinesia
• Tics or Tremors
• Lightheadedness
• Dry “Cotton” Mouth

Serious Side-Effects

• Edema or Swelling of the Hands/Feet
• Infection
• Accelerated or Irregular Heartbeats
• Fainting
• Eye Pain, Swelling, or Redness
• Widened Pupils
• Vision Changes (i.e., Reduced Vision, Blindness, etc.)

Note: This medication is designed to boost your serotonin levels, and as such, it could trigger cause your levels to skyrocket, leading to a serious, but rare condition, referred to as serotonin syndrome toxicity. This risk increases if you are also taking other medications designed to boost the amount of serotonin in your body, such as an SSRI.

Get medical help immediately if you develop one or more of the following symptoms:

• An Accelerated Heartrate
• Hallucinations
• A Loss of Coordination
• Severe Dizziness or Drowsiness
• Severe Nausea, Vomiting, and/or Diarrhea
• Twitchy Muscles
• An Unexplained Fever
• Unexpected Agitation and/or Restlessness

Can I Give Mirtazapine to My Child With OCD?

Do not give this medicine to OCD sufferers under the age of 18 (without permission from your child’s doctor). This medicine is not FDA-approved for children with OCD.

Is There Anything I Should Tell My Doctor About Before Taking This Medication for OCD?

Yes, inform your doctor if you have one or more of the following conditions because it could affect how mirtazapine works in your body.

• Low White Blood Cell Levels
• Glaucoma
• Liver Disease 
• Kidney Disease
• Low Blood Sodium Levels
• Seizures
• Depression
• Suicidal Ideation (Suicidal Thoughts and/or Suicidal Attempts)
• A Personal and/or Family History of Bipolar Disorder
• Heart Issues
• Strokes
• High Cholesterol or Triglycerides
• A Personal and/or Family History of Long QT Syndrome 
• Low Blood Pressure

Will Mirtazapine Interact with My Other Vitamin Supplements, Prescription Medications, and Herbs?

Possibly.

Mirtazapine may interact with other drugs and cause drowsiness. Thus, ask your doctor before taking an opioid, sleeping pill, muscle relaxer, seizure medication, or anti-anxiety medication.

Many drugs can interact with mirtazapine, such as:

• Cimetidine
• Diazepam
• St. John’s Wort
• Tramadol
• Tryptophan or L-tryptophan
• Antibiotics – i.e., Clarithromycin, Rifampin, Rifampicin, or Telithromycin
• Antifungal Medications – i.e., Itraconazole, Ketoconazole, etc.
• Antiviral Medications – i.e., Indinavir, Nelfinavir, Ritonavir, or Saquinavir
• Antidepressants or Antipsychotics – i.e., Lithium, SSRIs, etc.
• Migraine Medications – i.e., Sumatriptan, Rizatriptan, Imitrex, Maxalt, etc.
• Seizure Medications – i.e., Carbamazepine, Phenytoin, etc.

What Could Happen If I Suddenly Stop Taking Mirtazapine for My OCD Symptoms?

Do not suddenly stop taking mirtazapine for OCD, or you could experience an OCD relapse or withdrawal symptoms, such as dizziness, vomiting, agitation, profuse sweating, mental confusion, numbness, tingling, and/or an electric sensation.

References

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• Koran, L. M., Gamel, N. N., Choung, H. W., Smith, E. H., & Aboujaoude, E. N. (2005). Mirtazapine for obsessive-compulsive disorder: An open trial followed by double-blind discontinuation. The Journal of Clinical Psychiatry, 66(4), 515–520. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15816795/
• L M Koran et al. J Clin Psychopharmacology. (2001) – Mirtazapine treatment of obsessive-compulsive disorder https://pubmed.ncbi.nlm.nih.gov/11593084/
• Mowla, A., & Baniasadipour, H. (2022). Is mirtazapine augmentation effective for patients with obsessive-compulsive disorder who failed to respond to sertraline monotherapy? A placebo-controlled, double-blind, clinical trial. International Clinical Psychopharmacology. Retrieved from https://doi.org/10.1097/YIC.0000000000000415
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• Davis, R., & Wilde, M. I. (1996). Mirtazapine: A review of its pharmacology and therapeutic potential in the management of major depression. CNS Drugs, 5(5), 389–402. Retrieved from https://doi.org/10.2165/00023210-199605050-00007
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