For patients with chronic insomnia who haven't responded to trazodone or doxepin — and aren't candidates for CBT-I — new research in the Primary Care Companion for CNS Disorders suggests ultra-low-dose mirtazapine (3.75 mg) may be worth considering. Abstract -----> Objective: To ose mirtazapine (3.75 mg) improves insomnia without next-day effects. Methods: This retrospective study evaluated data collected from September 5, 2024, to March 7, 2025, from an outpatient setting consisting of veterans with insomnia who were treated with ultra–low-dose mirtazapine. The Insomnia Severity Index (ISI) was administered during the first appointment and at each subsequent visit with the respective psychiatrist to monitor insomnia symptoms. Summary statistics were used to compare ISI scores at baseline and 1–3 months after starting treatment. Results: Considering all veterans evaluated (N = 53), 47% showed a meaningful decrease in ISI value (greater than 7 points). Patients who completed treatment showed a constant or decreased ISI score (mean [SD] change: 11.3 [6.46]). Conclusion: Ultra–low-dose mirtazapine may improve symptoms and ISI values for chronic insomnia. #Insomnia #ChronicInsomnia #SleepDisorders #Mirtazapine #SleepMedicine #Psychopharmacology #Psychiatry #PrimaryCare #ClinicalPsychiatry #PCC #MentalHealth #VeteranHealth