This is a great question. Remember, ultimately, you are in charge of what goes in your body (whether it's medications, herbs, alcohol, nicotine, drugs, or food). Doctors are here to give you their best recommendations...it's a team approach...we're not supposed to order you around as if we always know what's best.
It's natural to be worried about side effects...especially since you had recent bad reactions to celexa & fluoxetine. One thing to keep in mind is that at your age & with your h/o being sensitive to side effects, I would go very slowly & conservatively with any med changes.
The 1st decision you half to make is this. You say that even with the 45mg dose you still at times feel low/agitated, but your depression has lifted. If you are content with this level of improvement, you do not have to change your meds.
Remember, depression is best treated holistically. Medications can be helpful for some people. I also recommend 1) psychotherapy with a live therapist, and 2) learning some formal relaxation therapy.
The last 2 treatments I mentioned are proven by sophisticated studies using brain scans (CT, MRI, EEG, pet scans) to improve brain function.
Most studies on depression show the best results are with a combination of medications & psychotherapy.
Also, by formal relaxation therapy I mean yoga, meditation
, or similar methods. Having relaxing hobbies is also important, but not quite the same as formal relaxation therapy. More studies are coming out in which people are incorporating relaxation therapy & mindfulness into psychotherapy...and the results look great. And these treatments have no side effects!!
And remember you can't separate emotional health from physical health, so exercise & nutrition are vital.
There are also several self-help books you can read which can help including: 1) The Seven Spiritual Laws of Success by Deepak Chopra, 2) The Feeling Good Handbook by David D. Burns; 3) The Relaxation & Stress
Reduction Workbook (New Harbinger Self-Help Workbook) by XXXXX XXXXX, and 4) The Depression Workbook: A Guide for Living with Depression and Manic Depression, Second Edition by Mary Ellen Copeland and Matthew McKay.
Using the above approach can help treat the residual symptoms for you (i.e. the leftover symptoms that the remeron 45mg is not treating).
That being said, if you do decide you want a med change. Here is how I would do it. Stay on the 45mg dose of mirtazapine. I wouldn't start on a 75mg dose for you (I use this dose for younger people, people who aren't sensitive to side effects, or hospitalized patients.).
I would start one of 2 ways: I would get 25mg tablets of venlafaxine (not the extended release version) and take 1/2 tablet in the morning...and then increase (as long as tolerated) to 1/2 tab twice a day. Or, you could start with 37.5mg of the extended release version in the morning.
In theory, the XR (extended release) versions are better b/c they are easier to remember once/day and have smoother blood levels through out the day. The smoother levels often mean less side effects for people. There are some patients, like those who get insomnia
or other side effects at nighttime, who do better on the non-XR versions. Despite all the science, there is a trial & error approach.
I hope this helps. Let me know if you need more feedback. Good luck & take care.
Please let me know if you need more information. We can continue the dialog until you are satisfied. Once you are happy with the answers don't forget to hit the ACCEPT button & provide expert feedback. Also remember that this is not an official doctor patient relationship and not a substitute for a full live psychiatric evaluation. Thank you for using justanswers.com