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

Most common
somnolence (up to 23%)
dry mouth (up to 18%)
nausea (up to 26%)
asthenia (up to 15%)

Remeron

Most common
somnolence (up to 54%)
dry mouth (up to 25%)
increased appetite (up to 17%)
constipation (up to 13%)

Paxil vs. Remeron Dosage

Paxil

Dosage
Dosage Table
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

Dosage
Dosage Table
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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