Mirtazapine and Sexual Side Effects

Introduction to Mirtazapine

• Mirtazapine has minimal to no sexual side effects and may actually improve sexual function in depressed patients, making it an excellent alternative for patients experiencing sexual dysfunction from other antidepressants 1, 2
• The American Academy of Family Physicians notes that mirtazapine promotes sleep, appetite, and weight gain, which can be beneficial for patients with depression accompanied by anxiety, insomnia, or poor appetite 1, 2

Dosing and Administration

• Mirtazapine should be started at 7.5 mg at bedtime, with a maximum dose of 30 mg at bedtime 1, 2

Side Effects and Considerations

• Weight gain is a primary concern with mirtazapine, as it causes more weight gain than sertraline, trazodone, or venlafaxine 3, 4
• Sedation occurs commonly with mirtazapine, especially at lower doses, though this can be therapeutically beneficial for patients with insomnia 1

Comparative Efficacy

• Paroxetine has the highest sexual dysfunction rate (70.7%) among all SSRIs 5
• Bupropion remains the single best option when sexual function is the primary concern, with an 8-10% sexual dysfunction rate 5

Mirtazapine and Sexual Side Effects

Comparison to Other Antidepressants

• Bupropion has significantly lower rates of sexual adverse events than fluoxetine or sertraline, according to the American College of Physicians, with an 8-10% sexual dysfunction rate 6
• Paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline, as reported by the American College of Physicians 6