Mirtazapine is not a mainstream PD medication. As stated a few times earlier in this thread, it seems to reduce tremor by calming you down (even though you may not feel that you need to be calmed down).

The main PD medication (the gold standard) is levodopa.

You said: "I was attempting to stave off starting levodopa due to possible eventual side effects". I believe that most movement-disorder-specialist neurologists do not share this concern. This is an issue which you could discuss at your appointment with your second movement-disorder-specialist neurologist.

Other classes of medication which you could discuss at that appointment include dopamine agonists and MAO inhibitors.

My wife started mirtazapine, now at 30 mg, five weeks ago. Not sure yet if it helps her psychosis but it does help her sleep.
I am surprised by the very few post on this forum concerning PD psychosis. Any thoughts?

Mirtazapine improves visual hallucinations in Parkinson's disease: a case report - Tagai - 213 - Psychogeriatrics - Wiley Online Library

Mirtazapine improves visual hallucinations in Parkinson's disease: a case report

Psychotic symptoms often occur as a complication in Parkinson's disease patients, and a set of criteria for Parkinson's disease with psychosis (PDPsy) has been established. Among these criteria, hallucinations are one of the specific symptoms, with visual hallucinations being the most common. While atypical antipsychotic agents are often used for the treatment of PDPsy, adverse effects, including extrapyramidal symptoms, often hinder its continuation or tolerance. There have been some reports and reviews indicating that antidepressants may be effective for PDPsy and other forms of dementia with psychosis. In this report, we present a patient with PDPsy who was treated with one of the new-generation antidepressants, mirtazapine. Mirtazapine improved the patient's refractory psychotic symptoms, especially her visual hallucinations, without worsening her motor symptoms.

Since PD is so much more than a "movement disorder", levodopa seems not to help with many symptoms that are not movement related, such as depression, sleep problem, constipation, urinary problems etc. In fact one quarter of the PD population are levodopa unresponsive , and I seem to be in that category. With PD it's not all about. Dopamine. PD affects other brain regions besides the dopamine nerve cells.

Thank you all for your replies. I very much appreciate your sharing thoughts!
Jeffreyn, I think there is some direct chemical mechanism to mirtazapine's effect on tremor rather than it being a matter of calming you down which then decreases tremor, since immediately upon awakening after taking the first dose the night before, I immediately saw a great decrease in tremor. I don't have a problem with anxiety and am generally not anxious.
Ashleyk, The source you cite is very hopeful that this or another antidepressant my help your wife experience decrease in psychosis. I hope to hear further good news about its effect for her as time goes by.
Blackfeather, I am surprised to learn a quarter of PWP are not helped by levadopa. I'm sorry to hear this has affected you. I will try to go back to older posts in the forum to see how you have managed symptoms without levadopa.

Fact is I am not doing very well and don't seem able to control symptoms. I now have neurogenic bladder failure and will have to have an indwelling Foley catheter stuck into my bladder for life. Taking morphine for pain in my dystonia in my now deformed right arm. Not a pretty picture.

Blackfeather, I've read some of your posts from earlier this year to try to get an understanding of your situation.

Now that you have been found to be unresponsive to levodopa, can you tell us what medications your neuro has now prescribed for you? Maybe someone will be able to give you some helpful advice.

MaryS said: "upon awakening after taking the first dose the night before, I immediately saw a great decrease in tremor"

Couldn't that have just been because the mirtazapine gave you a deeper night's sleep? I notice that when I do not get a good night's sleep, my tremor seems to be worse the next day.

I also take mirtazapine (15mg per day, in the evening). I take it to help me get a good night's sleep and to help with tremor (indirectly). My other medications are Madopar 125 (half tablet six times per day) and Azilect (1mg per day, in the morning). Tremor is my main symptom.

I am now under hospice care as of six weeks ago. Much better care and support than what my Neuro could offer. Have a nurse visit twice a week and a 24hr on call nurse if needed. There is an md in charge who I think understands PD better than my Neuro. They provide all medications and supplies. They also have a social worker.
Almost died from bladder failure and was hospitalised, and that's how I got connected with hospice. They have been great.