Does “California Rocket Fuel” Work? Carlat Reports

Does “California Rocket Fuel” Work?

The Carlat Psychiatry Report, Volume 5, Number 4, April 2007
https://www.thecarlatreport.com/newsletter-issue/tcprv5n4/

From The Carlat Psychiatry Report, April 2007, Pregnancy and Menopause in Psychiatry

Issue Links: Learning Objectives | Editorial Information | PDF of Issue

September 2019 update on this topic: When a popular antidepressant combination is discredited, what do we do with it? Dr. Chris Aiken sorts through the possibilities for mirtazapine (Remeron) augmentation, and pulls up a few more myths about this medicine. Listen to the podcast episode below or read full article this episode is based on from the September 2019 issue of The Carlat Psychiatry Report.

Louann Brizendine, MD

Founder, UCSF Women’s Mood and Hormone Clinic Lynne and Marc Benioff Clinical Professor of Psychiatry Author, The Female Brain

Dr. Brizendine has disclosed that she has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity. The author has disclosed that the estradiol patch has not been approved by the U.S. Food and Drug Administration for use in the treatment of depression. Please consult product labeling for the approved usage of this drug.

Subject:
Antidepressants

Short Description:
Does “California Rocket Fuel” Work?

Background:
The combination of Effexor (venlafaxine) and Remeron (mirtazapine) has been dubbed “California Rocket Fuel” by Stephen Stahl (see page 290 of his Essential Psychopharmacology, 2nd Edition) because of the multiple ways the combination boosts various neurotransmitter systems. The STAR-D study found that this combination outperformed the MAOI Parnate (tranylcypromine), though the difference was not statistically significant (McGrath PJ et al., Am J Psychiatry 2006; 163(9): 1531-1541). Psychiatrists in Ireland recently reported on a series of 32 patients with refractory depression who were given this combination. The response rate, based on the Clinical Global Impression Scale, was 44% at four weeks and 50% at eight weeks. Most patients who responded were on Effexor XR at 225 mg/day or higher and Remeron 30 mg to 45 mg HS. In terms of side effects, 12% of patients reported moderate to severe weight gain and another 12% reported at least moderate sedation (Hannan N et al., J Psychopharm 2007;21(2):161-164).

TCPR's Take:
Since this is only a case series, it doesn’t prove the value of Effexor/ Remeron, but the combination is fairly well tolerated and certainly worth trying in patients who have not responded to anything else.