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
Remeron
Prozac vs. Remeron Dosage
Prozac
Remeron
| 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 |
| 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
| 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
| 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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