Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo…
Worth asking your prescriber, if mirtazapine is being added on top of an SSRI or SNRI you already take, what specific benefit they expect — a large placebo-controlled trial found the combination added little and was harder to tolerate.
Top of the evidence hierarchy, independently funded. how we score evidence
In 480 primary-care patients still depressed after at least six weeks on an SSRI or SNRI, adding mirtazapine gave no clinically important benefit over adding placebo at 12 weeks (adjusted BDI-II difference -1.83, 95% CI -3.92 to 0.27), and 46 people on mirtazapine versus 9 on placebo stopped the drug because of adverse effects.
Worth asking
Worth asking your prescriber, if mirtazapine is being added on top of an SSRI or SNRI you already take, what specific benefit they expect — a large placebo-controlled trial found the combination added little and was harder to tolerate.
What it is FDA approved for
Read off the label. Trial duration and approval year are shown only where they were recorded — never inferred.
- Major depressive disorder (adults)
Source
Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR) — Kessler DS, MacNeill SJ, Tallon D, et al. (2018)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1136/bmj.k4218
DOI: 10.1136/bmj.k4218
How this was scored
- Study design
- Randomised controlled trial
- Funding
- Independently funded
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 480
- Preregistered
- Yes
- Conflicts disclosed
- Yes
- Independent of proponent
- Yes
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "gold standard". Top of the evidence hierarchy, independently funded. It scores 91 out of 100 on our published rubric. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR) — Kessler DS, MacNeill SJ, Tallon D, et al. (2018). Published in: Top-tier peer-reviewed journal. DOI: 10.1136/bmj.k4218. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Randomised controlled trial. Funding: Independently funded. The researchers were independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is mirtazapine (Remeron), remeron FDA approved?
Yes — FDA approved for Major depressive disorder (adults). Approval is for a specific indication, not for everything the drug is prescribed for.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.