What is your approach to initiation of mirtazapine for appetite stimulation and depression in older adults, both in terms of starting dose and titration?  

I consider initiation of mirtazapine for older adults who could benefit from at least two of the three potential effects of mirtazapine - improvement of mood, appetite, and/or sleep. I always start at a low dose of 7.5 mg nightly, potentially uptitrating to 15 mg nightly after a week or two if the m...

I start at 7.5 mg because I do want to assess the sedative effects of the drug on patients. If they tolerate it well for 1 week, but observe no change in appetite, I will jump to 15 mg at that point, but I tell them that if it doesn't work at that dose, it probably won't at a higher one. However, fo...