Remeron Fails to Help Treat Breathing Problems from COPD, Lung Disease: Study

Researchers warn that antidepressants like Remeron should not be prescribed off-label for breathlessness, as they may cause additional complications.

A new study indicates that antidepressants like Remeron do not help reduce symptoms of breathlessness associated with chronic obstructive pulmonary disease (COPD) or interstitial lung disease, and may actually cause additional side effects, which could even lead to death.

In a report published in the medical journal Lancet Respiratory Medicine on September 9, researchers from King’s College London warn against the use of Remeron and similar antidepressants to treat breathlessness, recommending that doctors not prescribe the drugs to patients for this “off-label” indication.

Remeron, also known by its generic name mirtazapine, is a common antidepressant prescribed for severe depressive disorder and anxiety. However, it is often prescribed off-label to patients with interstitial lung disease and COPD to help with symptoms of breathlessness.

In the study, researchers led by Dr. Irene J. Higginson conducted a double-blind randomized trial at 16 centers in seven countries, including Australia, Germany, Ireland, Italy, New Zealand, Poland and the UK, from 2021 to 2023

The study included 225 adults with COPD, interstitial lung disease or both conditions, who also experienced serious symptoms of breathlessness. Patients were given a placebo or Remeron for 56 days. The Remeron dose began at 15 mg and was increased to a maximum of 45 mg per day throughout the treatment.

According to the data, by day 56 the patients in both groups were no longer experiencing any improvement in breathlessness. However, there were more side effects experienced in the Remeron group.

A total of 64% of patients in the Remeron group had side effects, compared to 40% in the placebo group. Six Remeron participants suffered 11 serious side effects, compared to eight side effects among seven participants in the placebo group.

Moreover, by day 56, three people in the Remeron group had died, compared to only two in the placebo group. By six months, seven people in the Remeron group died.

As a result of the findings, researchers highlighted the importance of medical providers being cautious when prescribing drugs off-label, since research often hasn’t been conducted to evaluate the safety or efficacy of  those specific uses.

Antidepressants Can Lead to Additional Difficulties

Although antidepressants are widely used, the drugs do come with a number of known risks, especially among certain groups of patients.

Among older patients, prior research has found that taking antidepressants can increase a person’s risk of experiencing delirium.  This can also increase the likelihood that an older person might suffer a fall, resulting in life-changing injuries.

Another study conducted by researchers from the University of Michigan linked taking Remeron to an increased risk of getting infections like clostridium difficile (C. diff), which is a serious infection that causes diarrhea and inflammation in the colon. It can be life-threatening.

Unnecessary use of prescription medications that have not been shown to be effective in treating an underlying condition can also increase the risk of drug interactions, or delay the administration of more effective therapies.

“Based on existing best evidence, early identification and non-pharmacological approaches should be first-line treatment for the symptoms of breathlessness,” Higginson said. “These include an appropriately personalized approach to symptom management, with a continuum of approaches including pulmonary rehabilitation in earlier stages, interventions to improve peripheral muscle strength, and, when patients have more advanced disease, breathlessness support services that combine respiratory and palliative approaches, as all have been shown to be effective in randomized controlled trials and systematic reviews.”