There are not as many conditions where the multiple therapy prescription is the right option. This can be a case of a resistant depression where doctors can opt for drug combination in order to get a better result.
It is advised not to mix the same class of drugs so the therapy usually includes different drugs, such as SSRI and atypical antidepressant. Using both SSRI drugs can lead to a complication known as “serotonin syndrome” which can be very serious and end up in multiple negative outcomes.
Doctors opt for different medications, depending on the patient’s condition, but it is mostly a combination of an antidepressant with some kind of stimulant, antipsychotic or an anxiolytic. In not so many cases, doctors choose to use two types of antidepressants since they think it will work better for the present case. It is important to investigate both medications and its interactions prior to its use. Both drugs should have synergistic mechanisms which will help and benefit to the retreat of depression symptoms. One type of drug combination such as this one is a “California rocket fuel”.
What Does “California Rocket Fuel” Mean?
“California rocket fuel” is a slang used by the psychiatrists and other medical professionals that involve therapy using Remeron (Mirtazapine) and Effexor (Venlafaxine). It has been given this name due to its efficacy since it is a good combination for many suffering from resistant depression. It gives fast results with great improvement of depression symptoms.
Effexor (Venlafaxine) is a drug used for major depressive disorders, panic disorders as well as for anxiety. It is in the group of drugs called SNRIs (selective serotonin and norepinephrine reuptake inhibitors). It is on the market since 1993 and it was one of the first antidepressants approved for major depression by the FDA. It is considered to give good results and its daily dose goes around 37.5-375 mg per day. It should not be combined with MAO (monoamine oxidase inhibitors) since it can result in fatal conditions. It is also proven that it has an impact on a fetus during the third trimester, so it is advised not to be taken during pregnancy. It can also cause some side effects such as constipation, headaches, anxiety, insomnia, dry mouth, impotence, decreased sex drive, dizziness, blurred vision.
It belongs to SNRI which is a class of drugs that uses the mechanism of inhibition of reuptake of serotonin and norepinephrine. By doing this, it increases the levels of these neurotransmitters in the blood and leads to increased effects of these neurotransmitters. It has a stronger inhibition of serotonin than norepinephrine, thus, it has an impact on depression symptoms withdrawal. Some people claim that Effexor, being the part of SNRI, has better results than SSRIs.
Remeron is an atypical antidepressant. It belongs to NaSSA or noradrenergic and specific serotonergic antidepressants. It has a mechanism of action by blocking the α2 adrenergic auto- and heteroreceptors and also inhibiting the 5-HT2 and 5-HT3 serotonin receptors in the brain and nervous system in general. By doing this, it increases the serotonin levels by stimulating its release. It has an impact on histaminergic (H1) receptors by blocking them and as well as the muscarinic receptors. Its primary use is for depression, but it can be also used as a drug of choice as an appetite modulator and as an antiemetic drug, as well as anxiolytic and hypnotic. It is approved in 1996 by the FDA for depression treatment.
Since it blocks the alpha-2 receptors as well as some serotonergic receptors, it helps with neurotransmission of norepinephrine and serotonin, which is crucial for depression. It is important to state that this type of drug does not affect all of the serotonergic receptors which are important when combining with other drugs since it can lead to some adverse side effects if specific receptors are affected.
“California Rocket Fuel” Efficacy
Researchers have found some useful information about this kind of a drug combination. There are several studies that show the efficacy of Effexor and Remeron synergistic action. It is also important to state that the effects of this kind of a treatment depend on every individual and its current condition.
A was conducted among 32 patients with the combination of Venlafaxine and Mirtazapine. After only 4 weeks, there were some signs of improvement which was shown as well on the end of 6 months of use, where 75% of the patient showed symptoms retreat. Some have experienced minor side effects such as sedation and weight gain. Five patients have withdrawn from this therapy due to having this kind of adverse effects. This kind of results add-on to the conclusion that this kind of a combination can be helpful for treating depression symptoms.
Another was conducted among 105 patients using randomized, double-blind study. It was in 2009 and it lasted for 6 weeks. The outcome of the study was positive for drug combination as well, where the patient had symptoms improvement. They used Remeron in various combinations starting with 225 mg of Effexor, 150 mg of Wellbutrin and 20 mg of Prozac. All of the three combinations mentioned had significant improvement in depression symptoms. The most efficient one was Remeron + Effexor with the percentage of HAM-D score of 58% followed up with 52% of Remeron + Prozac combination and the last one, Remeron + Wellbutrin with 46% of HAM-D score.
California Rocket Fuel Benefits
When using this combination, there are several reasons why doctors and patients tend to like California Rocket Fuel rather than other drug options.
Remeron being the NaSSA drug blocks the targeted receptors and improves the serotonin and norepinephrine neurotransmission. This is also similar in Effexor, but with a different mechanism of action. It inhibits the reuptake of serotonin and norepinephrine, thus giving the similar results by which this kind of drugs react synergistically.
People react well to both drugs with some minor adverse effects. Patients have responded well to both drugs in combination and in monotherapy, where the Effexor and Remeron have helped them with depression symptoms relief.
People, as well as some studies, have confirmed the efficacy of both drugs, as well as their combination. The results were encouraging and it suggested that it can lead to major depression symptoms improvement.
Due to a high tolerance development, many antidepressants combination have an inferior tolerability. Some say that this combination including Effexor and Remeron have a better tolerance than others. Still, there are some side effects which can be on a downside, such as weight gain with both drugs.
Are There Some Rocket Fuel Improvements?
Some say that there are different combinations of antidepressants which are an improved strategy for depression symptoms relief. This is due to Pristiq (Desvenlafaxine) promotion since it is a newer drug and Effexor. They have a similar result in the body, but the different ratio of serotonin and norepinephrine inhibition. It is here where the Pristiq would be a better option due to its ratio of 10:1 serotonin vs norepinephrine. This is all in theory due to different tolerance of Pristiq among patients. Some say they have reacted better and with greater symptoms improvements, and some have contradictory statements. There aren’t many studies regarding this type of combination, so we will have to see the progress of this type of combination.
Have you been taking this kind of combination? What is your reaction to California Rocket Fuel? Leave a comment down bellow so we could add-on to the study results mentioned above.