"i have been on 60mg mirtazapine with 75-150mg effexor for about a year. it helped my depressive symptoms a lot at first, but over time i&#039;ve had diminishing returns. though i find it nearly impossible to be stressed or depressed on these meds, i still remained suicidal in a &quot;philosophical&quot; way. it reached a point where action was required, and now i am experimenting with adding lithium to the mix. i encourage those who are not responding well enough on antidepressants alone to consider adding a low dose of lithium. my suicidal ideation has been at least blunted. good luck all."