Paxil vs. Remeron
See how Paxil and Remeron compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Paxil (paroxetine) is an SSRI approved for six conditions including depression, OCD, panic disorder, and PTSD, while Remeron (mirtazapine) is only FDA-approved for major depressive disorder in adults.
Remeron causes more sedation and appetite increase, making it a common off-label choice for insomnia or poor appetite, while Paxil is less likely to cause daytime drowsiness or weight gain.
Both carry a boxed warning for increased suicidal thoughts in young people and should not be combined with MAOIs.
Paxil vs. Remeron Drug Summary
Paxil
Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) FDA-approved for major depressive disorder, OCD, panic disorder, social anxiety, generalized anxiety, and PTSD. It's typically taken once daily as an immediate-release tablet, though extended-release and liquid forms are also available.
Remeron
Remeron (mirtazapine) is a tetracyclic antidepressant FDA-approved for major depressive disorder in adults. It's taken once daily, usually at bedtime because of its sedating effect, and is often prescribed off-label for insomnia or appetite stimulation.
Paxil vs. Remeron Side Effects
Paxil
Remeron
Paxil vs. Remeron Dosage
Paxil
Remeron
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 50 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | At the start |
| Maximum dose | 45 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Paxil
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 50 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Remeron
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | At the start |
| Maximum dose | 45 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Paxil vs. Remeron Indications
Paxil
Paxil is FDA-approved to treat major depressive disorder along with several anxiety-related conditions. It's one of the few SSRIs cleared for OCD, panic disorder, and PTSD, making it a versatile option for patients with overlapping anxiety and mood symptoms.
Major depressive disorder
Obsessive-compulsive disorder
Panic disorder
Social anxiety disorder
Remeron
Remeron is FDA-approved only for major depressive disorder in adults. Because of its strong sedating and appetite-stimulating effects, clinicians frequently prescribe it off-label for insomnia, anxiety, or appetite loss, though these uses aren't FDA-approved.
Major depressive disorder (FDA-approved)
Insomnia (off-label)
Anxiety disorders (off-label)
Appetite stimulation (off-label)
Paxil vs. Remeron Pros and Cons
Paxil
Paxil offers FDA-approved coverage for multiple anxiety disorders beyond depression, and decades of clinical use back its safety profile. It requires careful review of other medications due to strong CYP2D6 inhibition, and stopping it abruptly can trigger more noticeable withdrawal symptoms than other SSRIs.
Pros
Approved for six conditions including OCD, panic disorder, and PTSD, broader coverage than mirtazapine
Available as immediate-release, extended-release (Paxil CR), and liquid suspension
Long clinical track record dating back to 1992
Less likely to cause daytime drowsiness compared with Remeron
Cons
Strong CYP2D6 inhibitor, requiring dose adjustments for many other medications
Short half-life makes missed doses more likely to trigger withdrawal-like symptoms
Roughly $300 to $310 per month without insurance, more expensive than generic mirtazapine
Contraindicated with MAOIs, pimozide, or thioridazine, limiting medication combinations
Remeron
Remeron's sedating and appetite-stimulating effects make it useful for depression with insomnia or poor appetite, though it's only FDA-approved for depression itself. Its rare risks of neutropenia and QT prolongation call for monitoring in some patients.
Pros
Sedating effect taken at bedtime often helps with sleep alongside depression treatment
Available as an orally disintegrating tablet for patients who have trouble swallowing pills
Simple three-step titration schedule reaches a stable maintenance dose quickly
Generic mirtazapine typically costs $10 to $40 per month, far less than brand-name Paxil
Cons
FDA-approved only for major depressive disorder, so other uses are off-label
Significant appetite increase and weight gain are common and may be unwanted
Rare but serious risk of severe neutropenia or agranulocytosis
Reports of QT prolongation and Torsades de Pointes require caution in heart patients
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