Prozac vs. Remeron

See how Prozac and Remeron compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Prozac is an SSRI approved for several conditions, including OCD, bulimia, and panic disorder, while Remeron is a tetracyclic antidepressant approved only for major depressive disorder.

  • Prozac tends to be activating and can cause insomnia or anxiety, while Remeron is more sedating and often causes drowsiness and increased appetite.

  • Both carry a boxed warning for suicidal thoughts in children and young adults, but Remeron also carries a rare risk of severe neutropenia that requires blood monitoring.

Prozac vs. Remeron Drug Summary

Prozac

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) approved for major depressive disorder, OCD, bulimia nervosa, panic disorder, and treatment-resistant depression when combined with olanzapine. It's available as a capsule, tablet, oral solution, or once-weekly delayed-release capsule after an initial daily titration.

Remeron

Remeron (mirtazapine) is a tetracyclic antidepressant approved for major depressive disorder in adults. It's typically taken once daily at bedtime as a standard tablet or an orally disintegrating tablet (SolTab) for those who have trouble swallowing pills, with sedation often more noticeable at lower doses.

Prozac vs. Remeron Side Effects

Prozac

Most common
insomnia (up to 33%)
nausea (up to 21%)
anxiety/nervousness (up to 15%)
somnolence (up to 12%)

Remeron

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

Prozac vs. Remeron Dosage

Prozac

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily At the start
Maximum dose 90 mg once weekly If needed
Dose changes 2 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

Prozac vs. Remeron Indications

Prozac

Prozac is FDA-approved for major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, panic disorder, and treatment-resistant depression when paired with olanzapine. It's also used off-label for premenstrual dysphoric disorder, binge eating disorder, and social anxiety disorder.

  • Major depressive disorder

  • Obsessive-compulsive disorder (OCD)

  • Bulimia nervosa

  • Panic disorder

Remeron

Remeron is FDA-approved only for major depressive disorder in adults, a narrower approval than Prozac's. Off-label, it's sometimes prescribed for insomnia, anxiety disorders, or to help stimulate appetite and weight gain in cancer or elderly patients.

  • Major depressive disorder

  • Insomnia (off-label)

  • Anxiety disorders (off-label)

  • Appetite/weight stimulation (off-label)

Prozac vs. Remeron Pros and Cons

Prozac

Prozac has the broadest FDA approval list of the two, covering depression, OCD, bulimia, and panic disorder, and its long-acting metabolite allows a once-weekly dosing option. It's been on the market since 1987, so long-term safety data and low-cost generics are well established.

Pros

  • FDA-approved for OCD, bulimia, and panic disorder, not just depression

  • Once-weekly dosing option after initial titration

  • Long track record with well-established generic pricing

  • Non-sedating profile for people who want to avoid daytime drowsiness

Cons

  • Can cause activating side effects like insomnia and anxiety

  • Long-acting metabolite means interactions can linger after stopping

  • Requires a 14-day gap before or after taking an MAOI

  • Not approved as monotherapy for generalized anxiety disorder

Remeron

Remeron's sedating effect can help people with depression who also have insomnia, and its tendency to increase appetite can be useful for those who've lost weight from illness. Its use is limited to a single FDA-approved indication, and it requires monitoring for a rare but serious blood cell risk.

Pros

  • Sedating effect can help with comorbid insomnia

  • Appetite stimulation can help patients who've lost weight

  • Available as an orally disintegrating tablet for easier swallowing

  • Simple once-daily bedtime dosing with only three dose steps

Cons

  • Significant weight gain and increased appetite are common

  • Risk of severe neutropenia requires blood count monitoring

  • FDA-approved only for major depressive disorder

  • High rates of daytime drowsiness, especially early in treatment

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