Thanks Simon

I had read your start up effects but thought I'd got away with it for the first few hours

This is not much worse than missing a dose of pregabalin and at least it reminds me of how bad I was before I went on that, so I'll be able to measure improvement against how I feel today.

Insomnia makes my anxiety unbearable, I would much rather have anxiety and sleep OK than have insomnia.

That said the anxiety became difficult to cope with on mirtazapine alone for 5 years, so I'm trying to achieve relief from both now.

My GP is aware of the combination as he reissued me with a mirtazapine prescription at the same time.

It was me that told him they could be combined though, he's doesn't normally prescibe duloxetine apparently. I was his guinea pig for pregabalin too, as he'd only prescribed that for nerve pain before.

I did get the info on drug combinations from an NHS site though. And I am aware of the risk of serotonin sydrome, I've been on AD augmented therapy before (Citalopram & mirt, fluoxetine & mirt, now duloxetine & mirt).

Also I'm only on 15mg of mirtazapine, which is why it's actually classed as augmentation rather than combination I believe (one AD at a low dose non-therapeutic level enhances the effects of the AD that is at a therapeutic dose).

I genuinely appreciate your concern but I did do my research