SSRI/SNRI + mirtazapine (Remeron) combination -- too optimistic? Experiences please.
I'm looking for any experiences on using mirtazapine combinations, such as the famed 'Rocket Fuel'. Research suggests such combos are highly effective for patients like myself (resistant depression & other disorders), but actual experience reports are scarce on the internet and it's hard to know exactly what it feels like to be on this, and what areas it can help. I am trying this in a few weeks if mirtazapine still doesn't help enough.
Personal history and notes on self in small text, skip past if you don't care:
I believe I've had some form of mental peculiarity since birth, which started out as heavy introversion, lack of social drive, no assertiveness and a general inability to 'thrive' and engage with / enjoy life as much as others. To this day I feel I lack some crucial 'spark' that drove everyone else forward, and with the increased social pressures of my teenage years came social anxiety, anhedonia, depression, and a lot more. Before those 'pressures' I was somewhat different, but still capable of happiness if I followed a certain lifestyle. I think that door is now closed and only a combination of meds, therapy and a lot of time will begin to re-open it.
I don't have a low self-esteem; my failure at life I put down to some sort of brain abnormality that could be genetic. I don't blame my upbringing -- my folks are the nicest and most competent parents in the world. I'm not unintelligent, physically ugly or fat, or at any other obvious observable disadvantage. You could say it's just my personality, but when my personality means I am doomed to be unhappy with just about any form of human contact, it's not one I intend to keep (at least the bad parts anyway). Maybe I can become a recluse when I'm older, but for now human contact is a necessity.
When your brain is naturally configured to derive such a minimal amount of enjoyment from any normal activity of life, drugs can be both a miracle and a one-way ticket to dependency. I found that the more selective a drug is to dopamine, the more effective it is for just about every problem I have. When I've taken pure dopamine-acting drugs I experienced everything "click into place" and I was 'normalised', with motivation, interest, enjoyment, concentration, sociability and everything else finally making sense. I was finally able to tolerate life, not because of some high, but because everyone needs a certain amount of these chemical effects to keep the brain ticking over. What might get user A high may just get user B normal, and there are big differences between recreational and therapeutic use of dopaminergics, not the least of which being dose. Unfortunately the means with which to target dopamine are currently limited and burdened with side-effects like anxiety, so I came to the decision that I must first get my anxiety and typical depression under control before directly influencing dopamine (what I feel is very close to the core of my disorder, partly from personality / genes and partly from previous drug use).
Because dopamine itself is so insanely pleasurable, it's hard to separate genuine "hypo-dopaminergic" people from those with unrelated mood disorders, since pumping most people full of dopaminergic drugs would make them more happy and able to tolerate life. It's easy to just write off the whole thing as dangerous territory, which it is if you're not careful.
That brings me to mirtazapine combos. I have tried SSRIs alone before and found they made me happy in some ways but worsened some of my other problems like inability to experience pleasure (anhedonia) and those relating to motivation & concentration. In contrast to dopamine drugs, it didn't feel like an overall "serotonin effect" was really what my brain was craving AKA "the missing jigsaw piece", but it was positive on many levels. I would definitely take the good side of SSRIs if the negatives weren't so pronounced, hence my optimism with mirtazapine augmentation. I am currently on 45mg mirtazapine, which takes the edge off depression/anxiety but also flattens emotions and imagination (in a different way to SSRIs). It's not a bad med for me, but still doesn't control anxiety, anhedonia, depression enough that I'm able to get on with my life. I'm still consistently unhappy, regardless of what I do with myself, and anxiety is still very much a problem.
I think SSRIs alone were never gonna do the trick for me with their anhedonic sides, and whilst mirtazapine seems a better monotherapy for my brain, its benefits remain minor. My pdoc has agreed to add an SSRI if mirt shows no further improvement in a few weeks. Mirt should block the side-effects of SSRIs that previously limited their effectiveness, and promote a powerful synergy and hopefully relief of most of my symptoms. I don't know how well it will work on motivation/concentration/sociability/anhedonia, but at least it should get me out of this pit of depression and reduce anxiety enough that I can tolerate coffee to boost my brain (e.g. dopamine, noradrenaline, acetylcholine) like the rest of the world, or I suppose more powerful psychostimulants if I eventually discover all that drug abuse has given me real ADD.
So, if any of you have used mirtazapine with other antidepressants, I'm all ears. Specifically I want to know exactly how it made you feel, whether benefits faded over time, whether there were any side-effects, and how it compared to each antidepressant alone. Cheers.