Mirtazapine and trazodone are both prescriptions in a class of drugs known as antidepressants. They’re used for several purposes, including the treatment of depression, anxiety, and insomnia. Mirtazapine may also be used to treat other issues like post-traumatic stress disorder (PTSD) and nausea. Trazodone and mirtazapine are antidepressants used for similar purposes, but they work differently in the brain.

Trazodone works as a serotonin modulator. It can activate some serotonin receptors and block others. Mirtazapine is a tetracyclic antidepressant that works as an antihistamine, alpha-blocker, and a serotonin antagonist. Still, the two drugs produce similar effects and side effects, such as weight changes, nausea, dizziness, and drowsiness. However, they also have a few unique side effects among them.

Both drugs can be dangerous when mixed with alcohol and other medications like depressants, opioids, and sleep aids. While they can both be effective in treating sleep problems like insomnia, one or both may not be the best option for your needs. Sleep problems and mental health disorders are complex, and treatment should be tailored to your needs.  

Learn more about mirtazapine and trazodone and how they compare in treating sleep problems. 

Are Antidepressants Used to Treat Insomnia?

Depression and sleep problems can sometimes occur at the same time. In some cases, depression and mental health issues can be an underlying cause of sleep issues. Depression can cause hypersomnia, which is when low energy and motivation cause you to sleep more than usual. But it may also cause insomnia or sleep disturbances when your mental health issues keep you up at night or prevent you from getting restful sleep. In that case, sleep problems may feed into one another. A lack of sleep can worsen your physical and mental health. 

Antidepressants can help address some of the biochemical problems that cause depression, but some can also act as a sedative. Trazodone and mirtazapine both have sedating effects in addition to their effects as antidepressants. There are several treatment options when it comes to treating common mental health issues like depression. Treatment should be tailored to your individual needs; there is no silver bullet for problems like mental health and sleep disorders. 

The first line of defense for sleep issues is to work on your sleep hygiene, which are common practices that can help improve your sleep and sleep quality. You may also try non-pharmacological options light therapy or cognitive behavioral therapy (CBT). Some over-the-counter medications can also help improve sleep, like some antihistamines. 

However, if insomnia continues to trouble you after trying these approaches, your doctor may suggest trying a prescription sedative. Prescription sleep aids don’t work for everyone, so you may need to go through a process of trial and error with your doctor to find the right medication and dose for your needs. 

Prescriptions like mirtazapine and trazodone may be high on the list of options if you’re struggling with mental health and sleep disorders simultaneously. Sedating antidepressants can slow down the nervous system to facilitate sleep and a release of anxious thoughts. 

What is Mirtazapine?

Mirtazapine is a drug sold under the brand name Remeron in the United States. It’s a prescription medication primarily used to treat depression, but it can also be used to treat anxiety and insomnia. It’s known as an atypical antidepressant, which is a drug with antidepressant effects that don’t act like other common antidepressants. 

Most antidepressants are serotonin reuptake inhibitors, which means they work by blocking the removal of serotonin, which increases the levels of this neurotransmitter. Serotonin is tied to positive feelings of happiness and well-being, so increasing your levels of serotonin may help many people with depression. 

Mirtazapine works differently in the brain, although its mechanism of action isn’t fully understood. The drug also has antihistamine effects, which lends itself to the drug’s ability to cause sedation and facilitate sleep. Mirtazapine can take up to four weeks to effectively treat depression, but it may start working as early as two weeks. 

Mirtazapine was first approved for medical use in the United States in 1996, and generic versions of the medication became available in 2004. 

What Is Trazodone?

Trazodone is a drug that’s sold under several brand names, including Desyrel and Oleptro. Like mirtazapine, it’s primarily used to treat depression, but it also has other uses as a treatment for anxiety disorder and alcohol dependence. It’s relatively well-tolerated, but it has common side effects that are similar to mirtazapine. Its sedating effects make it useful as a sleep aid for people with insomnia. 

Unlike mirtazapine, trazodone is a typical antidepressant in that it works with serotonin in the brain and nervous system. Serotonin is an important neurotransmitter that seems to have a relationship with problems like depression and other mental health issues. Increasing serotonin may alleviate some symptoms of anxiety and mood disorders. 

Trazodone has been used in the United States longer than mirtazapine since it’s been approved since 1981. It’s also available as a generic medication. Trazodone is extremely popular, even when compared to mirtazapine. In 2019, it was the 25th most commonly prescribed medication in the United States. 

What are Mirtazapine’s Side Effects?

Mirtazapine is relatively safe, but it can come with several common symptoms. Some symptoms can be serious and require immediate attention from a doctor. Since there is no one medication that works for everyone, it’s important to work closely with your doctor when you’re taking a new prescription medication. Switching medications or adjusting your dose may provide benefits with fewer side effects. Some common side effects of mirtazapine include drowsiness, dizziness, increased appetite, and weight gain. 

Serious side effects may be less common but may require medical attention. Serious side effects include mania, low white blood cell count, and increased suicide risks. White blood cells help fight off infections. If the drug is affecting your white blood cells, you may experience fever, sore throat, chills, injections, and flu-like symptoms. 

Increased suicide risk is more common in adolescents. It may come with feelings of hopelessness, worthlessness, loss of interest in normal activities, and apathy. It’s important to know that these symptoms are temporary and may go away with treatment. 

  • Agitation
  • Hallucinations
  • Tachycardia (fast heart rate)
  • Loss of balance
  • Loss of coordination
  • Tremors
  • Stiff muscles
  • Confusion
  • Problems with your memory
  • Overactive reflexes
  • Sweating
  • Hypnosis
  • Extreme nausea
  • Sores in your mouth or on your lips
  • Inability to focus
  • Severe headache

Mirtazapine can also cause uncomfortable withdrawal symptoms. Withdrawal happens after a period of regular use that leads to chemical dependence. If you stop using the drug abruptly, it can cause irritability, nausea, dizziness, vomiting, sleep disturbances, headaches, and pins-and-needles sensation. 

What are Trazodone’s Side Effects?

Trazadone is a similar drug to mirtazapine, and many of their common side effects can overlap. However, since they work differently in the brain, they don’t have some distinct effects on the body. When you start taking trazodone, make a note of any new symptoms or symptoms that persist or get worse. Like mirtazapine, there is no guarantee that trazodone is the right drug for your needs. Switching medications or adjusting your dose may help you find relief from insomnia, with fewer disruptive side effects.

You may encounter some common, mild side effects when you start taking the drug that eventually goes away. Common side effects include:

  • Dry mouth
  • Dizziness
  • Fatigue 
  • Lightheadedness
  • Nausea
  • Headache
  • Diarrhea
  • Constipation
  • Changes in weight

Trazodone can also cause more serious side effects that may need medical attention, including manic episodes and irregular heartbeats. Mirtazapine can also cause an increased risk of suicide. If you have suicidal thoughts while on this medication, it’s important to speak to someone as soon as possible and recognize that these feelings may be a temporary side effect. 

Trazodone can also cause some uncomfortable withdrawal symptoms, including irritability, anxiety, insomnia, confusion, headaches, and dizziness.

Which Medication Is Better: Mirtazapine or Trazodone?

When you’re deciding on prescription medication with your doctor, there are many variables to consider, especially when something as complex as sleep problems are involved. Neither drug is the first prescription option you’re likely to try if you ask your doctor about insomnia treatment. There are several other options before antidepressants. However, if you also have a mood disorder or depression, you may try one of these antidepressants that also help facilitate sleep. 

Both mirtazapine and trazodone are prescribed for sleep, but they have their strengths and weaknesses. Trazodone is sometimes said to be more effective for sleep but less effective in treating depression. Mirtazapine is sometimes said to cause more weight gain. However, people may respond to each medication differently, and it sometimes takes a trial and error process to find the right medication for your needs.

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