Doctor, I need your help on a very important issue. I am taking 30 mg Remeron each night as wellas Xanax .5mg twice a day.

I have had very high cortisol on my 24 hour urine tests and morning serum cortisol tests.I do have various of the symptoms of hypercortisolism, but not some others...no moon face, pad of fat on my upper back/neck, no skin striations.

My question is this: I read that Remeron affects the cortisol levels...maybe that they suppress serum cortisol or it could have been that Remeron increases it.My ID doc doesn't know the answer, but do you or could you possibly speak with a psychopharmacologist at your institution to help us understand whether the Remeron or Xanax ( and I also take Proscar) could cause elevated cortisol in urine or serum tests? I read that someone at Columbia has studied the effect of Remeron on cortisol.

Could these be false positives due to drug effects? The night beforeone 24 hour urine test for cortisol, I took just 15mg of Remeron (usually 30 mgs) - could the lower dose that time have caused a rebound effect...resurgence of cortisol the next day that resulted in higher urine cortisol?

Thank you so much.

Your high cortisol levels are definitely not due to Remeron (mirtazapine). Remeron is an antidepressant that is known to cause a decrease in cortisol levels in both healthy and depressed people.