California rocket fuel a combo of Remeron and Effexor which can give a triple boost to the serotonin system, a double boost to the norephinephrine system, and a single boost to the dopamine system.
This combo has an all-or-nothing reputation in the biz. The "nothing" being all side effects and little mood improvement. But it's a combination some folks have had great relief from if the Effexor wasn't doing it for them. I is also very cool to say - the sort of medicine that makes you think "Gee, I wish I was depressed so I could try that."