Tuesday, 31 January 2012

California Rocket Fuel- Lift Off!

Ok, so let's get personal. Talk about Love and Other Drugs. Ok, mainly drugs.

I have recently started seeing a new psychiatrist to treat my resistant unipolar depression. Doc was unimpressed that I have not been responding (well my waistline has been responding, but we'll get to that later) to venlafaxine aka Effexor, despite the high dose I'm on. He told me there is an anti psychotic, Zyprexa, which, taken in low doses for two weeks, can give the Effexor a "zap", kind of like jump starting a car. Cool? Cool. Wait, not so cool. I was a drooling, spaced out zombie mess for four days, before I kicked it to the kerb.

Missy fails yet another "I'll fix you, take this pill" test.

So, now Doc's bring out the big guns. Or Rockets. Enter "CALIFORNIA ROCKET FUEL". This is the colloquial name for a combination of two drugs, Effexor and a drug called Mirtazapine, aka Avantin. Recommended by Californian therapists the world over. Let's see what medscape.com has to say about it...

"Use of the tetracyclic antidepressant mirtazapine in combination with fluoxetine, venlafaxine, or bupropion is more effective and as well-tolerated in treating major depressive disorder (MDD) as fluoxetine alone, according to results from a new double-blind comparison study published in the December issue of the American Journal of Psychiatry.
In fact, patients treated with these combinations had mean differences of 4.5 to 4.8 points on the Hamilton Depression Rating Scale (HAM-D) by day 42 compared with those treated with monotherapy."

"For years, [California psychopharmacologist] Dr. Steven Stahl has said that the combination of mirtazapine and venlafaxine is 'California rocket fuel,' but I wasn't aware of any controlled trial looking at that. The results here for that combination are quite impressive, as are the combinations with the other drugs in this study. Going forward, this is a good approach in everyday clinical practice to treat depression."

Wow. Sounds like I'm well on the road to recovery. Well not yet. "Why not?" you say "chuck these new pills down your throat and get better and stop whinging already!!!" Well, I can't start until the weekend, as apparently the Avanza knocks you out even MORE than Zyprexa. Cue weekend in bed for me (this side effect apparently wears off after 2-4 days of taking it). Ok. Awesome. Except there's one more side effect that DOESN'T wear off. Appetite stimulation, leading to rapid weight gain. Shit.

To be, or not to be. Specifically, to be fat and happy or skinny and suicidal. Not that either is totally acheivable. I've never been a small girl. But if I get bigger, I'm going to have worse self esteem, and so not happy, whereas if I don't take it, I'll stay still bigger than normal, and unhappy. How fucked up is that?

There's no real point to this post. Just musing over the fucked up-ness of our medical model of treating mental health issues. I think I need to move to a nudist colony and start growing organic chickpeas or something. Feel free to share your drug dilemmas...

UPDATE 23/3/2012: The combinations of medication is going great, and I haven't gained a lot of weight (prob 1-2kgs). Recommend this treatment for anyone with resistant depression (in conjunction with pycho-social treatment of course.... The social worker in me can't condone a drugs only

UPDATE 22/9/2013: I know I should have updated this again earlier ... But I'm lazy, ok!?!?  I took Effexor + Avanza for about 9 months, and it was ok. I did end up putting on about 4 kgs,,, No great but tolerable. I then had a turn for the worse (life circumstances, more than medication, I believe) but, doctors decided to wean me off Effexor and try Dothep (dothiepin). It was a good call, Dothep has worked better than the other drugs I've tried. Just a word of warning: DO NOT GO OFF EFFEXOR UNLESS YOU ARE BEING CLOSELY SUPERVISED BY A PSYCH. The withdrawals are insanely horrible. You feel so fucking sick. And the brain zaps OH JEEZ THE BRAIN ZAPS! Can't explain to people who haven't been there, but essentially what I mean is that people need to be connected with a good doctor when medication is involved; I don't get those people who just get their script and screw around with their dosage and just think everything is fine. Rant complete.


  1. " The combinations of medication is going great, and I haven't gained a lot of weight (prob 1-2kgs). Recommend this treatment for anyone with resistant depression"

    A couple of years back while weaning off Mirtazapine I got started on Cymbalta (another SNRI)and found myself very energetic for certain exercise runs.

    when you found this combo worked for you was it because you were more energetic?

  2. So pleased for you, I've had amazing results with this medication. I've had crippling anxiety since a child and the past two weeks have been a dream. No anxiety? what's going on! I'm keeping an online journal myself to document my journey, very positive!

  3. It took a week or so. It was rough, i was a drooling zombie. Week two effects are getting better. Urge to smoke is lessening. Im getting positive, i feel positive.