I have taken almost every type of antidepressant made over the past 24 years and when the doctor asked me which one worked the best, I said Nardil. That's an MAOI which has all those dangerous food interactions. So, she got creative and gave me Effexor XR, a tiny dose of Provigil (prescribed for narcolepsy) and an extra shot of straight T3. She was trying to "immitate" Nardil. It pretty much did the trick. Effexor XR acts upon seratonin, norepinephrine, and has a tiny effect on dopamine. The normal drowsy reaction was counteracted by the Provigil and the T3(Cytomel) boosted the uptake of the Effexor. I'm getting pretty good results with almost no side effects. Since I'm bipolar, my dose is 225 mg and I take a mood stabilizer at night.