Remeron vs. Elavil for Depression: Important Differences and Potential Risks.

Key takeaways

Mirtazapine (Remeron) and amitriptyline are both used to treat depression, but they belong to different classes of antidepressants. Mirtazapine is a tetracyclic antidepressant, while amitriptyline is a tricyclic antidepressant (TCA). Mirtazapine is available as a generic and comes in oral and dissolvable tablet forms, typically taken once daily at night. Amitriptyline, also available as a generic, is usually taken in divided doses throughout the day or as a single dose at bedtime. Mirtazapine is known to cause sleepiness and weight gain, but it is less likely to cause nausea or sexual problems compared to other antidepressants. Amitriptyline also causes sleepiness and weight gain but has more interactions with other medications and can cause additional side effects like dizziness, dry mouth, and constipation. Both medications can take 1 to 2 months to show full benefits and should not be stopped suddenly to avoid withdrawal symptoms.

Mirtazapine

(Remeron)

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Amitriptyline

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Summary for Remeron

Prescription only

Mirtazapine (Remeron) is an atypical antidepressant (or more specifically, tetracyclic antidepressant). It's used to treat major depressive disorder (MDD) in adults. Mirtazapine (Remeron) is available as an oral tablet and orally disintegrating tablet (ODT) that's taken once daily, typically at night. Some common side effects of this medication include sleepiness and dry mouth. Mirtazapine (Remeron) can also raise your appetite and put you at risk for weight gain.

Indications for Remeron

Major depressive disorder (MDD) in adults

Pros and Cons for Remeron

Pros

Taken by mouth once daily
Available as a dissolvable tablet for those who can't swallow pills
Less likely to cause sexual side effects compared SSRIs
Available as a lower-cost generic

Cons

Can take up to 2 months before you feel the the full benefits
More likely than other antidepressants to cause weight gain
Can cause sleepiness
Risk of withdrawal symptoms if you suddenly stop taking it

Common Side Effects for Remeron

Sleepiness (54%)
Dry mouth (25%)
Feeling more hungry (17%)
Constipation (13%)
Weight gain (12%)
Weakness (8%)
Dizziness (7%)

Warnings for Remeron

Worsening depression, suicidal thoughts, and unusual behavior
Higher risk of infection (from low white blood cell count)
Serotonin syndrome
Withdrawal
Not for bipolar disorder
Glaucoma
Life-threatening abnormal heart rhythm (QT prolongation)
Severe allergic and skin reactions
Difficulty concentrating and extreme sleepiness
Seizures
Low blood sodium levels
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only

Summary for Elavil

Prescription only

Amitriptyline is also known by the old brand name Elavil. It's a tricyclic antidepressant (TCA) that's approved to treat depression. But it's not used as often today for depression because it can cause a lot of side effects, like sleepiness and weight gain. It also has many drug interactions. Even so, amitriptyline is often used off label for other reasons, like nerve pain from diabetes and to help prevent migraines. Amitriptyline comes as a generic tablet that you take by mouth. The brand name Elavil is no longer available.

Indications for Elavil

Depression

Pros and Cons for Elavil

Pros

Can start to work within 2 to 4 weeks
Can take with or without food

Cons

Has many unpleasant side effects, like dry mouth and sleepiness, and drug interactions
Not the best choice for people with heart problems, trouble urinating, or glaucoma or older adults