Trazodone and mirtazapine are common medications prescribed to treat mental health conditions like depression, anxiety, and sleep disorders. Even though they share some of the same therapeutic applications, these drugs have several differences that are important to be aware of. For example, they have distinct mechanisms of action, side effect profiles, and specific uses — all of which can play a role in determining which one might be more suitable for your condition, symptoms, and needs.
Understanding the differences between trazodone vs mirtazapine is crucial for making informed decisions about your treatment options. Keep reading to learn more.
Differences Between Trazodone and Mirtazapine
While both trazodone and mirtazapine are used to treat depression, they’re not in the same drug class, and they have different mechanisms of action. They also might cause different side effects. Trazodone is a serotonin antagonist and reuptake inhibitor (SARI), whereas mirtazapine is a tetracyclic antidepressant. Understanding these and other distinctions between trazodone and mirtazapine is crucial for determining the most effective treatment plan.
| Drug | Conditions treated | Main side effects | Key considerations |
| Trazodone | Depression, anxiety, insomnia | Drowsiness, dizziness, dry mouth, nausea, risk of priapism (rare) | Often prescribed for insomnia due to sedative effects
Lower risk of weight gain compared to Mirtazapine Only available in generic forms, making it an affordable option |
| Mirtazapine | Depression, anxiety, insomnia, OCD, PTSD, generalized anxiety disorder, social anxiety disorder, panic disorder | Increased appetite, weight gain, drowsiness, dry mouth | May lead to significant weight gain; monitoring of weight is recommended
Sedative effects can be beneficial for patients with insomnia but might be problematic when treating depression Lower doses can be more sedating than higher doses, thus dosing should be individualized |
How they work
Trazodone is a serotonin antagonist and reuptake inhibitor (SARI). SARIs work by blocking serotonin receptors and inhibiting the reuptake of serotonin, increasing levels of the neurotransmitter in the brain. This dual action can effectively relieve depressive symptoms while also promoting sleep if you have depression-related insomnia.
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Get an evaluation and prescription for Trazodone from a psychiatric provider licensed in your state.
Mirtazapine, on the other hand, is an atypical tetracyclic antidepressant. Experts don’t fully understand how mirtazapine works, but they believe it’s by increasing noradrenaline and serotonin levels in the brain. This dual mechanism enhances antidepressant effects and can also improve sleep quality for some people.
Sedation effects
Both trazodone and mirtazapine have sedative properties. In studies, the drugs were similarly effective in more than 60% of participants — but they differ in their strength depending on dosage. Trazodone is used off-label — meaning it’s not FDA-approved to treat a specific condition but can offer benefits — at lower doses to treat insomnia. Mirtazapine’s sedative properties can be particularly beneficial for people who have depression and insomnia. However, the sedative effect of mirtazapine can be so strong that it might limit who’s able to tolerate it.
Onset of action
In terms of alleviating depressive symptoms, mirtazapine may have a faster onset of action compared to some other antidepressants. For sleep improvements, both trazodone and mirtazapine can promote sedation shortly after taking them, but like any drug, individual responses can vary.
Side effects
The side effects of these medications are notably different. Trazodone commonly causes drowsiness, dizziness, dry mouth, and nausea. There’s also a rare but serious side effect of trazodone called priapism, which is a prolonged and painful erection.
Mirtazapine is associated with increased appetite, significant weight gain, drowsiness, and dry mouth. You should discuss any potential side effects and drug interactions with your doctor or psychiatrist to determine the most appropriate medication.
Use in depression
While trazodone and mirtazapine are both used to treat depression, research suggests that mirtazapine can be more effective than Trazodone in some people. Mirtazapine is often prescribed as a standalone treatment for major depressive disorder, and it might be preferred for people seeking rapid symptom relief.
Trazodone is sometimes used as an adjunctive therapy to other antidepressants, especially when insomnia is also present. It’s rarely used on its own to treat depression.
“I can help clients understand why a prescriber might choose one medication over another. For example, Mirtazapine can help with sleep and appetite, while other options might be better for those who want to avoid weight gain or drowsiness. I encourage clients to talk with their prescriber to find the best fit for them.”
Similarities Between Trazodone and Mirtazapine
Even though they have their differences, trazodone and mirtazapine do have several similar uses. For example, as we’ve noted, these drugs are both effective in treating and managing symptoms of depression, anxiety, and sleep disturbances — and they also offer benefits that can be tailored to individual personal requirements.
Conditions treated
Mirtazapine and trazodone can be used to treat major depressive disorder (MDD), insomnia, and anxiety. Because they both have sedative properties, they may help with sleep disturbances as well as certain mood disorders.
Adjunctive use
Sometimes, these drugs are used in combination with other medications to enhance outcomes. For example, taking trazodone with a selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant (TCA) can be an even more effective treatment option for depression or anxiety.
Mirtazapine can be used alone to treat depression, but it’s generally only used when other drugs haven’t worked. Sometimes, it’s used as an adjunct to SSRIs for depression or with an antipsychotic to treat schizophrenia.
Tolerability
Trazodone and mirtazapine are generally well-tolerated by most people who take them. Still, it’s essential to watch for intense sedation, fatigue, or daytime drowsiness that might be problematic, especially when starting treatment or increasing dosages. Your doctor will monitor all the side effects you experience if you’re taking either of these drugs, and they can make adjustments to the dosage or your entire treatment plan if needed.
FAQs About Trazodone and Mirtazapine
It’s normal to have questions about the efficacy, side effects, and usage of any new drug you’re considering taking, including trazodone and mirtazapine. Addressing your concerns and educating yourself will offer clarity so you can make an informed decision about your treatment plan.
Is trazodone or mirtazapine better for sleep?
Both trazodone and mirtazapine are commonly prescribed off-label for sleep, but which one is better depends on your specific needs. Trazodone is often preferred for individuals who need help falling asleep and is generally well-tolerated at lower doses. Mirtazapine, on the other hand, may be more effective for those struggling with both sleep disturbances and appetite loss or depression, as it has sedative and appetite-stimulating effects. Side effects, such as next-day drowsiness or weight gain, can also influence which medication is the better choice for you. Consulting with a doctor can help determine the best option based on your symptoms and overall health.
Can trazodone and mirtazapine be used together?
Since trazodone and mirtazapine work by increasing serotonin levels, combining them is generally not recommended. Taking these drugs together can increase the risk of a serious, potentially life-threatening condition known as serotonin syndrome. Always talk to your doctor before you combine any medications.
Does mirtazapine cause more weight gain than trazodone?
Yes, studies have shown that mirtazapine is more likely to cause weight gain than trazodone. If you’re worried about gaining weight, you should share your concerns with your doctor when you discuss treatment options.
Which works faster for anxiety: trazodone or mirtazapine?
Mirtazapine can have a faster onset of action in reducing anxiety symptoms when compared to trazodone. Like all drugs, though, the length it takes mirtazapine to work can vary, and your treatment plan should reflect your specific needs, condition, and medical history.
Which Medication Is Right for You?
Before deciding between trazodone and mirtazapine, you need to consider several factors, such as the symptoms you’re treating, potential side effects of a medication, personal preference, and whether you have any other comorbid conditions. Your doctor may even recommend a different mirtazapine alternative other than trazodone if there’s a more effective option.
Get Professional Guidance with a Prescription
The best way to get an effective treatment plan is to work with a psychiatrist or your doctor to decide which medication is the most appropriate for your needs. There are pros and cons of all drugs — even when you look at trazodone vs. mirtazapine — so it’s important to seek help before you start or switch medications.
Talkspace offers accessible, affordable online mental health support and medication management. Online psychiatry services simplify the process and ensure you get the help you need. Connect with an online psychiatrist today to learn more about how to get a mirtazapine or trazodone prescription and find out if one of these medications is right for you.