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.
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).
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