MajorOther antidepressants (NaSSA)×Selective serotonin reuptake inhibitors (SSRIs)
Updated · Methodology
Mechanism
SSRI augmentation with mirtazapine in resistant depression is possible ('California rocket fuel'). Additive serotonergic effect is rare, but serotonin syndrome has been reported at high doses of both.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, fever.
Management
The combination is used for antidepressant augmentation. Keep doses low: sertraline 100 mg, mirtazapine 30 mg/day. Monitor blood pressure and mental status in the early weeks.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Remeron (mirtazapine) prescribing information (2020)– ; DailyMed setid 98ad1917-a094-44f5-a28f-a64a8cfcd887
- AEMPS: Ficha técnica: Mirtazapina (nº registro 67068), sección 4.4 (2026)– AEMPS, CIMA, nº registro 67068, revisión 06/2026, sección 4.4