I just started this same combination with Duloxetine (Cymbalta) added 5 days ago for depression and chronic low back pain. I was started on Mirtazapine 15 mg for 2 months with little effect then bumped to 30 mg for 3 months still with little effect on depression. I went from losing weight before starting Mirtazapine to gaining almost 30 pounds! I couldn't stop eating. Also alcohol intake was getting out of hand. Sometimes a fifth of vodka in two days. I was actually craving alcohol and I never had before. After I read about Cymbalta and alcohol I stopped drinking before the meds arrived in the mail. I'm now on 15 mg Mirtazapine and 40 mg Duloxetine. Pros: NO alcohol cravings! No appetite. I have to force myself to eat so what few calories I now eat I make sure has a lot of protein, vitamins and fiber. I have also started sleeping longer and through the night without waking up several times for no reason. Cons: Mental confusion. Hard to explain but I just feel "weird". I've learned not to stand up to fast or I get really dizzy. Anxiety is actually a bit worse. I'm actually worse at completing tasks I've set for myself too. I don't feel like a zombie but something is changing and I hope it's for the better. Mirtazapine did nothing for my depression or back pain. It only made me fatter. If I had stayed only on Mirtazapine I likely would have drank myself to death. I drank from the time I got up until I went to bed. I hope the doctor weans me off it completely. While I'm seeing some side effects from the Duloxetine they're not debilitating in any way. At least I'm seeing some effect from the meds and that gives me hope. I've been depressed most of my life and the VA was the first doctor to actually listen to me and work hard to help me. I injured my lower spine 14 years ago and have been living with the pain. I refuse to get addicted to pain pills. Duloxetine seems to be prescribed a lot for chronic pain. I really hoping it works for my back pain.