depression meds what a mess?

I have dr.s appointment tomorrow and I need to switch antideppresants. I am on remeron and have been for 7 years, but sometimes it stops working. The dr...he or she .....always asks how I know its not working. I don't have then patience to answer that question but I try my best. I've been on 13 different antideppresant since the age of 17. I'm a walking PDR. Physicians desk reference. How the hell do I talk to an ear nose and throat dr about this? the nearest psychiatrist or ph..any phs are too expensive and far away and its winter and the roads arent good for my little geo. Tomorrow, how do I say I need a different medication and receive an answer without a referall, which I don't need. I've been on every pill in the pharmacy and know more about my condition and medication than they could imagine.

But forget about the questions I asked above. The answer will be simple, but living through it won't be, so maybe just give me feedback? I honestly don't want advice. I know what it will be. But this really sucks. Can anybody relate? That's all I want to know.