Aloha Dave,

Since you are posting in the "treatment resistant" forum I am assuming you have had a variety of drugs prescribed over the years. I'm guessing that you're running out of options because Mirtazapine is a weak anti-depressant medication to use as a primary medication for someone with long-term, severe depression. Mirtazapine is the strongest anti-histamine available and works great for insomnia but not so good as a "stand-alone" for severe (or even moderately severe) depression.

If you want to read more about Mirtazapine you might look up Dr. Ken Gilman (psychotropical) who has done extensive research about this drug.

In my own case, Mirtazapine has been a life saver because it's the only drug that allows me to sleep. Unfortunately there are no more anti-depressant medications for me to use, all have failed to help. But, I've had 75 meds over 25-years.

I would encourage you to work with your physician to find a better/stronger primary anti-depressant medication if there are some you haven't tried yet. Best wishes