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Psychopharmacology book

California Rocket Fuel

California Rocket Fuel

“California Rocket Fuel”, popularized by psychiatrist Stephen Stahl, is a combination of venlafaxine (SNRI) and mirtazapine (noradrenergic and specific serotonergic antidepressant, NaSSA). This combination boosts serotonin and norepinephrine neurotransmission in multiple ways.

California Rocket Fuel by Dr Jason Cafer MD

The STAR-D study found this combination to be at least as effective as the MAOI tranylcypromine (Parnate). In a series of 32 patients with refractory depression, 44% responded at four weeks and 50% at eight weeks (Hannan et al, 2007).  The combination was generally well tolerated, although 12% of patients reported moderate to severe weight gain and, 12% reported at least moderate sedation.


Unfortunately, larger studies were disappointing. For 112 patients who failed to respond to venlafaxine, remission rate was 39% when mirtazapine was added, compared to 72% when venlafaxine was changed to the TCA imipramine (Navarro et al, 2019).


Mirtazapine (REMERON)

Venlafaxine (EFFEXOR)

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