Mirtazapine for insomnia

A study found low-dose mirtazapine (7.5 mg to 15 mg per day) provided a statistically significant and clinically relevant reduction of insomnia severity at 6 weeks vs. placebo but not at later time points, whereas for low-dose amitriptyline, the reduction was statistically, but not clinically relevant (1):

• low doses of the antidepressants amitriptyline and mirtazapine are widely prescribed as an alternative treatment when there is a need for sleep medication that can be used for several months
• demonstrates a statistically significant and clinically relevant effect of low-dose mirtazapine (7.5-15mg/day) on insomnia severity at 6 weeks, but not at 12 weeks during treatment nor at follow-up up to 12 months

Reference:

1. Bakker M et al. Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder with sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING). BJGP.2024.0173.