Rozerem vs. Remeron for Insomnia and Depression: Important Differences and Potential Risks.

Key takeaways

Ramelteon (Rozerem) and mirtazapine (Remeron) are both prescription medications, but they serve different purposes and belong to different drug classes. Ramelteon is a melatonin receptor agonist used to treat insomnia by mimicking the natural hormone melatonin to help you fall asleep. It is taken by mouth 30 minutes before bedtime and is not habit-forming. On the other hand, mirtazapine is an atypical antidepressant used to treat major depressive disorder (MDD) by increasing serotonin and norepinephrine levels in the brain. It is taken once daily, usually at night, and can cause side effects like weight gain and sleepiness. While ramelteon is not known to cause withdrawal symptoms, stopping mirtazapine suddenly can lead to withdrawal symptoms. Additionally, mirtazapine is available in both oral and dissolvable tablet forms, whereas ramelteon is only available as an oral tablet.

Ramelteon

(Rozerem)

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Mirtazapine

(Remeron)

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Summary for Rozerem

Prescription only

Ramelteon (Rozerem) is a sleeping pill used to treat insomnia in adults. It belongs to the drug class known as melatonin receptor agonists and works like melatonin. Ramelteon (Rozerem) is taken by mouth, typically about 30 minutes before bedtime. Unlike some other prescription sleep medications, ramelteon (Rozerem) isn't a controlled substance nor known to be habit-forming. Side effects of ramelteon (Rozerem) aren't common, but can include drowsiness and dizziness.

Indications for Rozerem

Insomnia (difficulty falling asleep)

Pros and Cons for Rozerem

Pros

Taken by mouth
Not a controlled substance and isn't known to be habit-forming
Fewer side effects than some other sleep medications
Available as a generic medication

Cons

Shouldn't take with or right after a high-fat meal
Can interact with many medications, including fluconazole, rifampin, and fluvoxamine
Not recommended for people with sleep apnea or severe liver problems

Common Side Effects for Rozerem

Dizziness (4%)
Sleepiness (3%)
Fatigue (3%)
Nausea (3%)
Worsening insomnia (3%)

Warnings for Rozerem

Severe allergic reaction
Changes in behavior and unusual thoughts
Other causes of insomnia
Caution while driving
Hormonal changes

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