Hi XXXXXXX

Mirtazapine is an antidepressant, which also promotes sleep. However, the maximum sleep promoting action is seen at low dosages up to 15 mg/day. Hence, it is quite possible that you are feeling sleepy because of this medication even at the dose of 7.5 mg.

I hope you are taking this medicine at night. If not, shifting this to a night time dose will solve your problem. However if drowsiness returns even with night dosing, you need to review your medications and life style - if any of those are adding to make you drowsy. Some medicines especially benzodiazepines can make you drowsy. Similarly, alcohol consumption (if any), can make you drowsy.

If your doctor's don't find any other reasons to explain drowsiness, I present two options to you:

1. We can stop this medicine and restart other antidepressant, which in my opinion should continue for a few more months. There are many antidepressants without sleep inducing effects, one of which will surely suit you. I do not suggest remaining totally off anti-depressants for now, as one is supposed to continue them for at least 9-12 months after getting well.

2. We can continue mirtazapine at the current dose while adding wakefulness promoting agent like modafinil, which you can take in the morning. Although I do not prefer this option because of the needless expense involved, only your treating doctor can be the best judge of that.

You can discuss your problem with your treating doctor and the options available to take an appropriate informed decision.

I hope this helps. Let me know if you need clariication

Best wishes.

Dr Preeti Parakh,
MD Psychiatry

---