Posted by jrbecker76 on December 1, 2008, at 18:36:31
In reply to Re: Agomelatine/Valdoxan/Melitor, posted by Cecilia on December 1, 2008, at 14:39:24
>So you didn't notice much difference between agomelatine and Rozerem? Is the 5-ht2c agonism that weak? How come no one ever mentions an antidepressant effect for Rozerem? Also, I've often read that there isn't much, if any, advantage to taking Rozerem rather than melatonin. Do you think that taking melatonin on a regular basis could then have a similar effect to agomelatine? Lastly, do you intend to go on agomelatine alone or as an augmentor once it's available in the U.S.?
>Sorry for all of the questions. I'm just really interested in this new medication.
Hi, I don't want anyone to take away any objective comparison between agomelatine and Rozerem (ramelteon) since mileage will of course vary by individual, especially within the highly diverse audience that is this forum. However, for me, yes, they have been somewhat similar. If I would be forced to dissect further differences, I would say that ramelteon helps with sleep more than agomelatine did. Perhaps this is due to the short half-life of agomelatine, which is only a couple of hours. As for the mood effects, as mentioned, both of them tend to subtly enhance my mood and have a "calming" effect that is quite unlike other antidepressant therapies (e.g., SSRIs). On certain days, agomelatine's effect in this regard was stronger, but once again, I'm stretching in my ability to make an objective comparison looking back retrospectively at this point.I was originally skeptical about the utility of melatonergic agonists, especially given the fact that I suffer from atypical depression with SAD, and the theories are inconclusive on what role melatonin plays in this condition. Most of the user feedback I have heard about Rozerem is that it is not a strong hypnotic at all, and in fact, causes further sleep disruption. However, there seems to be a significant minority of users that do respond well to it, especially for those that use it as an augmenter.
Couple further things to keep in mind. I have always used both drugs in augmentation with a low dose of Cymbalta and Nefazodone (both taken at night as well). While initiating both agomelatine and rozerem, I found that sleep disruption was apparent for the first few nights, but ended up being of benefit (both for sleep initiation and sleep maintenance) after several days of use. In taking holidays from Rozerem, I notice that my mood worsens slightly. Not sure if this a mild withdrawal effect (studies have reported there is not one) or just my mood going back to baseline.
It is interesting to note that Rozerem is currently being studied in Ph III trials for add-on benefit in major depression.
Bottomline, will agomelatine be a useful option for depression and/or insomnia? Yes. Would I go so far as to say that most moderate-to-severe forms of depression can be treated monotherapeutically with this agent alone? No. Is the main mechanism of action the 5-HT2c antagonism or the M1/M2 agonism of this compound? Both. In vivo studies have already proved this much. But of course, in the end, what does it matter if the drug works?
Do I plan on trying it again when it comes on the market? Probably. However, I am also eager to try other sleep agents that might reach the market in '09 as well (e.g,. the 5-HT2A antagonist, eplivanserin).
JB
poster:jrbecker76
thread:865566
URL: http://www.dr-bob.org/babble/20081123/msgs/866135.html