Low dose mirtazapine or trazodone for sedation | Right Decisions

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Antidepressants: Quality prescribing - a guide for improvement
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Low dose mirtazapine or trazodone for sedation

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Low daily doses of mirtazapine (15mg) or trazodone (100mg or less), are commonly used to treat insomnia and anxiety symptoms due to their sedating antihistamine effects.^84,119 However, people commonly develop tolerance (usually within a couple of weeks) to such sedating effects and therefore longer-term use – as with B-Z drugs – may be inappropriate.

Antidepressants demonstrate mixed and limited effects for the treatment of behavioural and psychological symptoms of dementia,¹⁸ therefore, routine reviews may help to appropriately minimise doses and optimise non-pharmacological management.

The routine use of low dose mirtazapine for the treatment of depression should be reviewed, as the majority of clinical trials demonstrated efficacy with doses ≥30mg daily.^26,40,131 Therefore, if mirtazapine is considered as appropriate and necessary then increasing to 30mg per day within the first week of treatment with an agreed plan for follow up within two to four weeks to assess efficacy and tolerance may help to provide an optimal response.