Mirtazapine may be used in the treatment of depression; however, its use may be limited by its prominent sedative effects. Selective serotonin reuptake inhibitor (SSRI) combinationsReference Prospero-Garcia, Torres-Ruiz and Ramirez-BermudezIs dose escalation of antidepressants a rational strategy after a medium-dose treatment has failed?European Archives of Psychiatry and Clinical NeuroscienceCombined treatment with reboxetine in depressed patients with no response to venlafaxine: a 6-week follow-up studyMirtazapine augmentation in treatment-resistant major depressive disorder: an open label, six week trialEvidence that the SSRI dose response in treating major depression should be reassessed: a meta-analysisLithium augmentation in treatment-resistant depression: meta-analysis of placebo-controlled studiesSerotonin syndrome with mirtazapine–fluoxetine combinationA 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combinationTrazodone addition for insomnia in venlafaxine-treated, depressed inpatients: a semi-naturalistic studyFluoxetine augmentation in citalopram non-responders: pharmacokinetic and clinical consequencesA double-blind, placebo-controlled study of antidepressant augmentation with mirtazapinePharmacokinetic fluvoxamine–clomipramine interaction with favorable therapeutic consequences in therapy-resistant depressive patientA comparison of electroconvulsive therapy and combined phenelzine–amitriptyline in refractory depressionEffects of mirtazapine, paroxetine and their combination: a double-blind study in major depressionTo combine or not to combine? you need a full three months for maximum effectiveness. Mirtazapine (Remeron) Primer Mirtazapine (Tradename: Remeron) is an antidepressant in the Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) class. The medications used in their study as adjuncts to Remeron included: 20 mg Prozac (Fluoxetine), 150 mg Wellbutrin (Bupropion), and 225 mg Effexor (Venlafaxine). After I got home from church I just broke out in tears & I am not a crier. 2020 May 26;10:2045125320927309. doi: 10.1177/2045125320927309. A prospective 4-week semi-naturalistic study ( Employing the same rationale as SSRI–reboxetine combination, reboxetine has been added for patients not responding to venlafaxine alone in an open-label series – reasonable response rates have been reported ( Combinations of SSRI–MAOI and TCA–MAOI have been considered in the previous sections. Talbot, Peter S. The combination seems relatively safe at therapeutic doses, although careful consideration is needed for patients at risk of suicide. As for your job, I'd take them documentation and show them were venlafaxine can give a false positive and demand a review or ask to do another drug screening and have them do a full panel work up. But it was great to get me stabilized. I've found if I go without this medication my mood severely drops so it's important to never miss a dose.2 month now on mirtazapine and from the state I was in, it has turned around a whole lot. Hypomanic switches were reported in the RCT group of in-patients with treatment-resistant major depression ( There are two double-blind controlled studies of TCAs used in combination with mianserin ( As far as we are aware, there are no studies that investigate the combination of TCAs with mirtazapine, although the principles behind the combination would be similar to those for mianserin. I've rated 7 as this medication has made me gain weight like mad, I find I wake up during the night to eat, they certainly do give you the munchies but I can deal with that side effect if it means having a decent sleep. Mirtazapine may be used in the treatment of depression; however, its use may be limited by its prominent sedative effects. doi: 10.1002/14651858.CD010557.pub2. After a couple weeks I dropped down to 20 mg every other day so I could sleep better. I really would like to stay off the med. I do have highs that can last a few days or weeks then drop to low sometimes. Venlafaxine might be useful in achieving an antidepressant ‘top-up’ effect for patients who require a higher TCA dose than they could tolerate, but there is no direct clinical evidence for this. The first time I took this medication I was drowsy but so so hungry, I was literally half asleep eating a bag of Crisps. Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness,... Alcohol can increase the nervous system side effects of mirtazapine such as dizziness, drowsiness,... 2010 Aug;30(4):357-64. doi: 10.1097/JCP.0b013e3181e7784f.Fava M, Rush AJ, Wisniewski SR, Nierenberg AA, Alpert JE, McGrath PJ, Thase ME, Warden D, Biggs M, Luther JF, Niederehe G, Ritz L, Trivedi MH.Am J Psychiatry. This medication definitely helps me sleep as my anxiety would run wild at night causing sleepless nights, it's definitely great for the sleeping side of things and now that I'm used to it I don't feel it hanging on me the next day. It's makes me want to eat lots which is good if you need to gain weight.