My current episode of depression/anxiety started Oct 06 and doc decided to try Lithium instead of my usual med Effexor XR. I was getting worse with Lithium so doc added in 225mg Effexor XR. I have had good results with just Effexor previously. Before xmas doc decided to cut out the Lithium which was a rollercoaster of ups and downs. I have been completely off Lithium for a month now and doc put Effexor up to 262.5mg. Never on this high a dose before - 225mg was max but only for a few weeks. Had a couple of good weeks on 262.5 but now feel I am starting to slide again. Can this be possible on such a high dose? Doc also metioned changing to Zispin (Remeron) but I am terrified to change. Any advice really appreciated.