Why come off slowly
Stopping mirtazapine is usually harder than starting it. The relationship between the dose you take and its effect on the brain isn't a straight line — at lower doses, even a small reduction in milligrams can be a large change in effect. This is why prescribers increasingly recommend hyperbolic tapering: smaller and smaller reductions as the dose gets lower, rather than fixed steps.
In practice that means the standard strengths — designed for the treatment range, not for coming off — often can't give you the small doses the end of a taper needs. That's where a method like the one below, so you can measure a precise fraction, comes in.
The liquid method, step by step
- Cut a tablet to the portion you need with a pill cutter.
- Crush the piece between two spoons over a small plate.
- Stir it into a measured volume of water to make a known concentration — it will look cloudy, which is expected.
- Stir again immediately before drawing your dose; the active ingredient settles quickly.
- Measure your prescribed dose with an oral syringe and take it.
- Make a fresh liquid each day and discard any unused liquid in the rubbish.
Your step-by-step taper schedule
This is the Mirtazapine schedule from the RELEASE Toolkit, reproduced with permission. It's a starting point to discuss with your prescriber — you can pause, slow down or speed up depending on how you feel. Aim to reduce roughly every 2–4 weeks.
| Step | Daily dose | Liquid option (0.5mg/ml) | Capsules option |
|---|---|---|---|
| 1 | 45mg | 3 × 15mg tablets | — |
| 2 | 30mg | 2 × 15mg tablets | — |
| 3 | 22.5mg | 1½ × 15mg tablets | — |
| 4 | 18.5mg | 1 × 15mg tablet & 7ml liquid | — |
| 5 | 15mg | 1 × 15mg tablet | — |
| 6 | 11.5mg | ½ × 15mg tablet & 8ml liquid | — |
| 7 | 9.5mg | ½ × 15mg tablet & 4ml liquid | ½ × 15mg tablet & 2 × 1mg capsules |
| 8 | 8.5mg | ½ × 15mg tablet & 2ml liquid | ½ × 15mg tablet & 1 × 1mg capsule |
| 9 | 7.5mg | ½ × 15mg tablet | — |
| 10 | 5.3mg | 10.6ml liquid | 1 × 5mg & 1 × 0.3mg capsules |
| 11 | 4.3mg | 8.6ml liquid | 4 × 1mg & 1 × 0.3mg capsules |
| 12 | 3.6mg | 7.2ml liquid | 3 × 1mg & 2 × 0.3mg capsules |
| 13 | 3mg | 6ml liquid | 3 × 1mg capsules |
| 14 | 2.3mg | 4.6ml liquid | 2 × 1mg & 1 × 0.3mg capsules |
| 15 | 2mg | 4ml liquid | 2 × 1mg capsules |
| 16 | 1.3mg | 2.6ml liquid | 1 × 1mg & 1 × 0.3mg capsules |
| 17 | 1mg | 2ml liquid | 1 × 1mg capsule |
| 18 | 0.6mg | 1.2ml liquid | 2 × 0.3mg capsules |
| 19 | 0.3mg | 0.6ml liquid | 1 × 0.3mg capsule |
| 20 | Stop | You've completed the taper 🎉 | |
Highlighted steps are the most important — do not skip them.
| Step | Daily dose | Daily tablet / liquid / solution |
|---|---|---|
| 1 | 45mg | 3 × 15mg tablets |
| 2 | 37.5mg | 2½ × 15mg tablets |
| 3 | 33mg | 2 × 15mg tabs & 1.5ml liquid (2mg/ml) |
| 4 | 30mg | 2 × 15mg tablets |
| 5 | 26mg | 1 × 15mg tab & 5.5ml liquid |
| 6 | 22.5mg | 1½ × 15mg tablets |
| 7 | 18.5mg | 1 × 15mg tab & 1.75ml liquid |
| 8 | 17.8mg | 1 × 15mg tab & 1.4ml liquid |
| 9 | 15mg | 1 × 15mg tablet |
| 10 | 14.2mg | 7.1ml liquid |
| 11 | 12.8mg | 6.4ml liquid |
| 12 | 11.5mg | 5.75ml liquid |
| 13 | 10.5mg | 5.25ml liquid |
| 14 | 9.6mg | 4.8ml liquid |
| 15 | 8.7mg | 4.35ml liquid |
| 16 | 8mg | 4ml liquid |
| 17 | 7.5mg | ½ × 15mg tablet |
| 18 | 6.6mg | 3.3ml liquid |
| 19 | 6mg | 3ml liquid |
| 20 | 5.5mg | 2.75ml liquid |
| 21 | 5mg | 2.5ml liquid |
| 22 | 4.6mg | 2.3ml liquid |
| 23 | 4.2mg | 2.1ml liquid |
| 24 | 3.8mg | 1.9ml liquid |
| 25 | 3.4mg | 1.7ml liquid |
| 26 | 3.1mg | 1.55ml liquid |
| 27 | 2.8mg | 1.4ml liquid |
| 28 | 2.5mg | 1.25ml liquid |
| 29 | 2.2mg | 1.1ml liquid |
| 30 | 1.95mg | 3.9ml dilute solution (0.5mg/ml) |
| 31 | 1.7mg | 3.4ml dilute solution |
| 32 | 1.47mg | 2.94ml dilute solution |
| 33 | 1.25mg | 2.5ml dilute solution |
| 34 | 1.04mg | 2.08ml dilute solution |
| 35 | 0.85mg | 1.7ml dilute solution |
| 36 | 0.66mg | 1.32ml dilute solution |
| 37 | 0.48mg | 0.96ml dilute solution |
| 38 | 0.31mg | 0.62ml dilute solution |
| 39 | 0.15mg | 0.3ml dilute solution |
| 40 | Stop | You've completed the taper 🎉 |
Highlighted steps are the most important — do not skip them.
- Do not skip the final small-dose steps — they're the most important for preventing withdrawal.
- Don't skip days, alternate days, or suddenly stop.
- If withdrawal symptoms appear, you can return to your previous dose; when ready, reduce more slowly.
Schedule © The University of Queensland (RELEASE Toolkit), reproduced with permission. Dosing guidance: Dr Mark Horowitz.
Measuring smaller doses accurately
Use the right tool for your method — an oral syringe for liquids (your pharmacist can supply 1 mL, 5 mL and 10 mL sizes), or a milligram scale for weighing. Choose the smallest measuring tool that fits your dose: it's far more accurate for tiny amounts.
- Measure slowly and double-check before you take your dose.
- Read at eye level, against the syringe plunger's flat edge.
- Keep the concentration or method the same each day so doses stay consistent.
What withdrawal can feel like
Withdrawal effects vary a lot between people. They often come in waves — harder days followed by windows of feeling more like yourself. Common, usually-manageable effects include dizziness, "brain zaps", nausea, vivid dreams, irritability and low mood. They tend to ease if you hold at your current dose for a while before reducing again.
Questions for your appointment
- How quickly is it safe for me to reduce, and by how much each step?
- How long should I hold at each dose before the next reduction?
- What should I do on a bad day — hold, slow down, or pause?
- Which symptoms mean I should contact you sooner?
- Would a compounded oral liquid be more accurate for my lowest doses?