Sleep disorders are all too common with approximately 14.5% of the world reporting insomnia that requires medication.¹ If you struggle with depression, it can also disrupt your sleep and negatively affect your quality of life. Finding the right medication to address these challenges becomes crucial.

While there are other prescription medication options for sleep, mirtazapine (Remeron®) and trazodone (Desyrel®) are two antidepressants that have been clinically proven to treat insomnia and improve sleep quality.

At RedBox Rx, we prescribe mirtazapine and trazodone when our experienced providers determine the patient could benefit from medication. This direct comparison will help you understand the mechanisms, effectiveness and potential side effects of mirtazapine and trazodone.

If you do not experience depression and are looking for an acute treatment for sleep, our providers can help you find the right match from our other insomnia medications.

What is mirtazapine (Remeron^®)?

Mirtazapine is a medication prescribed for major depressive disorder. It belongs to a class of medications called tetracyclic antidepressants that work in the central nervous system to strengthen certain chemicals in the brain.²

Mirtazapine causes drowsiness and is one of several antidepressants prescribed for insomnia. Problems with falling asleep are common in people with a depression diagnosis.³

The most common dosage for sleep problems related to depression is 7.5 mg or 15 mg, however it can be prescribed up to 45 mg. Mirtazapine is taken once a day before bedtime.⁴

What is trazodone (Desyrel^®)?

Trazodone is a medication prescribed to treat depression, anxiety, and insomnia related to depression.⁵ It belongs to a class of medications called serotonin modulators and works by increasing the amount of the neurotransmitter serotonin in the brain to help maintain mental balance.⁶

Common starting dosage for trazodone for sleep is 150 mg per day, sometimes divided into multiple doses per day. Tablet doses often come in 50 mg, 100 mg or 150 mg tablets.⁷ It may take two weeks or more to feel the full effects of trazodone.⁸

What is the difference between mirtazapine and trazodone?

Both mirtazapine and trazodone work to increase serotonin levels in the brain and have proven effective for insomnia. Some studies have shown mirtazapine was better tolerated than trazodone by users.⁹ Trazodone does have more side effects than mirtazapine, particularly muscle pain and shaking that can make it uncomfortable for some users.¹⁰

While some people report results within the first week of using trazodone,¹¹ it can take two weeks or longer to reach its full effect. Mirtazapine can take a bit longer to take full effect. You can expect to feel the results within four to eight weeks, and giving it at least six weeks to work is recommended.¹²

How effective are mirtazapine and trazodone for insomnia and sleep disorders?

In a study of mirtazapine versus trazodone for insomnia, both medications were effective for over 60% of participants.¹³

Approximately 53% of mirtazapine users reported drowsiness after use. Studies have shown mirtazapine improves total time spent sleeping and provides better sleep quality. Mirtazapine may help decrease depressive symptoms and enhance sleep. Treating sleep problems could potentially improve depression symptoms simultaneously.¹⁴

In multiple clinical trials, trazodone has shown to be effective in improving sleep latency (time to fall asleep) and sleep quality.¹⁵ Trazodone has also been shown to improve daytime cognitive functioning in multiple studies by improving user sleep quality.¹⁶

How should mirtazapine and trazodone be taken for insomnia and sleep disorders?

Recommended dosing of mirtazapine for insomnia is once a day at bedtime. The starting dose is usually 15 mg per day but can be increased up to 45 mg per day as directed by your doctor. It is meant to be taken daily, long term. You may need a reduction plan from your provider to stop taking mirtazapine to minimize adverse effects.¹⁷

If you are prescribed trazodone for insomnia, it is best to take it shortly before bedtime. Lower doses are typically prescribed for insomnia compared to depression, between 25 mg and 100 mg. It is meant to be taken daily for insomnia and is generally safe to take over a long period of time.¹⁸ Do not stop taking trazodone suddenly as your provider will likely advise you to taper off.¹⁹

Can mirtazapine and trazodone be taken together for insomnia and sleep disorders?

Because both mirtazapine and trazodone increase serotonin levels in the brain, it is generally not advised to take the two drugs together. It can put you at higher risk for a rare but serious condition called serotonin syndrome. Symptoms of serotonin syndrome include confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering, shaking, blurred vision, muscle spasm or stiffness, tremors, incoordination, stomach cramps, nausea, vomiting and diarrhea.²⁰

Please contact your provider if you have any symptoms of serotonin syndrome.

How do the side effects compare for mirtazapine and trazodone?

Side effects for mirtazapine and trazodone are similar with a few notable differences.

Side effects for mirtazapine include:²¹ 

• Drowsiness.

• Dizziness.

• Anxiousness.

• Confusion.

• Increased weight and appetite.

• Dry mouth.

• Constipation.

• Nausea.

• Vomiting.

Side effects for trazodone include:²²

• Nausea.

• Vomiting.

• Diarrhea.

• Constipation.

• Changes in appetite or weight.

• Weakness or tiredness.

• Nervousness.

• Dizziness or lightheadedness.

• Nightmares.

• Muscle pain.

• Dry mouth.

• Rash.

• Sexual problems.

• Uncontrollable shaking of a part of the body.

• Stuffy nose.

• Tired, red or itchy eyes.

Mirtazapine vs. Trazodone Comparison Chart

How RedBox Rx can help

RedBox Rx makes receiving treatment for insomnia easy and affordable. We offer secure, private online consultations with licensed providers focused on your health.

Benefits of RedBox Rx include:

• Transparent, affordable, flat rates for medications starting at $20/month.

• $25 consultations with a U.S. licensed medical professional.

• No insurance required. No membership fees. FSA and HSA eligible.

• No office wait times or scheduling issues typical with physical medical practices.

• FREE shipping directly to you. One-time, monthly and quarterly subscriptions available.

Get started on your insomnia treatment journey with our assessment.