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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by orbital on November 5, 2010, at 22:04:27
I'm currently taking Paxil, my sleeping patterns are erratic at best. Trazodone, the Z-drugs etc currently don't work for me.
Remeron has provided relief in the past, but I find it too sedating (needing 12 hours of sleep), and more importantly it numbs my emotions. I never got weight gain from it, but did suffer from significant withdrawals after long term use.
Anyways, I was wondering about agomelatine. To those who have tried it, have you found it to be a good hypnotic? I would welcome SSRI-augmentation, but I'm mostly interested in regulating my sleep (melatonin makes me feel more depressed the next day).
Thanks :)
Posted by SLS on November 6, 2010, at 6:34:22
In reply to Valdoxan for sleep? vs Remeron, posted by orbital on November 5, 2010, at 22:04:27
> melatonin makes me feel more depressed the next day).
Me, too. That is why I was somewhat reluctant to try agomelatine. In the end, agomelatine made me feel very much the same as did melatonin. Agomelatine is unquestionably a drug worth looking at for treating major depressive disorder. Studies show that the stimulation of melatonin receptors and the blocking of 5-HT2c receptors are necessary for the therapeutic effect. Ramelteon (Rozerem), stimulates the same melatonin receptors as agomelatine, but is devoid of serotonergic activity. Ramelteon is also devoid of antidepressant effects. If depression is not an issue, perhaps you can try ramelteon first if you find it difficult to locate agomelatine. The 5-HT2c antagonism of agomelatine might actually disturb sleep at first. This was the experience that Ron Hill and I had with this drug. 5-HT2c antagonism will increase the release of DA and NE neurons in the prefrontal cortex (PFC) and modulate dopamine release in the nucleus accumbens. 5-HT2c and 5-HT2a receptors are antagonistic.
- Scott
Posted by Conundrum on November 6, 2010, at 12:26:39
In reply to Re: Valdoxan for sleep? vs Remeron » orbital, posted by SLS on November 6, 2010, at 6:34:22
> > melatonin makes me feel more depressed the next day).
>
> Me, too. That is why I was somewhat reluctant to try agomelatine. In the end, agomelatine made me feel very much the same as did melatonin. Agomelatine is unquestionably a drug worth looking at for treating major depressive disorder. Studies show that the stimulation of melatonin receptors and the blocking of 5-HT2c receptors are necessary for the therapeutic effect. Ramelteon (Rozerem), stimulates the same melatonin receptors as agomelatine, but is devoid of serotonergic activity. Ramelteon is also devoid of antidepressant effects. If depression is not an issue, perhaps you can try ramelteon first if you find it difficult to locate agomelatine. The 5-HT2c antagonism of agomelatine might actually disturb sleep at first. This was the experience that Ron Hill and I had with this drug. 5-HT2c antagonism will increase the release of DA and NE neurons in the prefrontal cortex (PFC) and modulate dopamine release in the nucleus accumbens. 5-HT2c and 5-HT2a receptors are antagonistic.
>
>
> - Scott
>
>
Its interesting because remeron is an alpha 2 adrenergic antagonist and 5 HT2A/C antagonist. Alpha 2 adrenergic antagonists like yohimbine are not antidepressants but it seems that adding the 5HT2C antagonism really helps. Remeron is also a 5HT3 antagonist which by itself like in the drug ondansteron is not an antidepressant.
Posted by ggggg123 on November 7, 2010, at 9:38:32
In reply to Re: Valdoxan for sleep? vs Remeron » orbital, posted by SLS on November 6, 2010, at 6:34:22
How long did you take ago for Scott? cheers
Posted by SLS on November 7, 2010, at 10:17:23
In reply to Re: Valdoxan for sleep? vs Remeron » SLS, posted by ggggg123 on November 7, 2010, at 9:38:32
> How long did you take ago for Scott? cheers
I was pissed. I stopped taking it after only 3 weeks. I didn't like the way I was feeling. I had thought to restart it, but my doctor agreed that my response pattern indicated a treatment failure.
- Scott
Posted by ed_uk2010 on November 7, 2010, at 10:43:55
In reply to Re: Valdoxan for sleep? vs Remeron » ggggg123, posted by SLS on November 7, 2010, at 10:17:23
Scott have you tried tianeptine yet?
Posted by SLS on November 7, 2010, at 11:04:26
In reply to Re: Valdoxan for sleep? vs Remeron » SLS, posted by ed_uk2010 on November 7, 2010, at 10:43:55
> Scott have you tried tianeptine yet?
No. However, I won't exclude it from further consideration.
Have you seen anyone with a more severe depression respond well to it?
Thanks.
- Scott
Posted by Conundrum on November 7, 2010, at 11:10:58
In reply to Re: Valdoxan for sleep? vs Remeron » ed_uk2010, posted by SLS on November 7, 2010, at 11:04:26
Thats the first thing I was thinking when I saw Scott is taking agomelatine. That responses people have had to it aren't very robust and the mechanism of action doesn't seem all the promising. When nothing else works its worth a shot though.
> > Scott have you tried tianeptine yet?
>
> No. However, I won't exclude it from further consideration.
>
> Have you seen anyone with a more severe depression respond well to it?
>
> Thanks.
>
>
> - Scott
Posted by ed_uk2010 on November 7, 2010, at 15:45:26
In reply to Re: Valdoxan for sleep? vs Remeron » ed_uk2010, posted by SLS on November 7, 2010, at 11:04:26
>Have you seen anyone with a more severe depression respond well to it?
Not sure. I've not known anyone 'in real life' who has taken it - it's not available here.
I think it has to be worth a try because of its different mechanism of action. It's not just more of the same.
Posted by orbital on November 7, 2010, at 16:16:30
In reply to Re: Valdoxan for sleep? vs Remeron » ed_uk2010, posted by SLS on November 7, 2010, at 11:04:26
Agomelatine sounds vaguely Prozac-ish.. I'll try it and see, though, if it doesn't help me sleep I'll use Remeron.
Tianeptine was quite good. It relieved my anxiety pretty quickly, and its effect on my depression (which was moderate at the time) was noticeable after several weeks. I liked it cos it didn't numb out my emotions. I'd say that, overall, it helped keep me "centered". Not sure if it would work for severe depression, but it's definitely worth a shot.
Cheers!
> > Scott have you tried tianeptine yet?
>
> No. However, I won't exclude it from further consideration.
>
> Have you seen anyone with a more severe depression respond well to it?
>
> Thanks.
>
>
> - Scott
Posted by ggggg123 on November 7, 2010, at 19:03:42
In reply to Re: Valdoxan for sleep? vs Remeron » ggggg123, posted by SLS on November 7, 2010, at 10:17:23
My sister is a doctor on a psychiatric ward, recently they tried to give a patient ago and after 2 weeks, they had to stop as she was having terrible side effects, I think she had nausea. Its weird because there were virtually no side effects in their clinical trials lol.
With regards to Tianeptine; the good drug guide states that it is good for the anxious depressed, whilst noradrenergic ad's are good for anergic states.
Posted by ggggg123 on November 7, 2010, at 19:08:20
In reply to Re: Valdoxan for sleep? vs Remeron » SLS, posted by ed_uk2010 on November 7, 2010, at 15:45:26
One more thing to add, the patient who was tried on ago in the psych ward had severe depression, totally treatment resistant, but she couldn't take the side effects. Venlafaxine is the gold standard on the psych ward.
ED UK, if you are from the uk, ago is available here and has been for a while. My sister works at Airedale Hospital in Yorkshire, England, United Knigdom, no offence intended.
Posted by ed_uk2010 on November 8, 2010, at 13:58:31
In reply to Re: Valdoxan for sleep? vs Remeron, posted by ggggg123 on November 7, 2010, at 19:08:20
>ED UK, if you are from the uk, ago is available here and has been for a while.
Yes, I know, thanks. I was talking about tianeptine.
Posted by orbital on November 9, 2010, at 20:01:38
In reply to Valdoxan for sleep? vs Remeron, posted by orbital on November 5, 2010, at 22:04:27
and it might well be my last! I started feeling drowsy soon after taking my first agomelatine pill last night. I then spent the entire night drifting in and out of sleep, in a semi-awake haze (hard to describe). Finally "woke up" 7 hours later, feeling like I'd been run over by a truck.
Dizzy / vertigo all day long, bad headache, agitation .. took a nap and woke up feeling extremely anxious, palpitations etc.
Thinking I might skip tonight's dose and reassess, I've never reacted so badly to a med before. Funny, my doc was raving about it yesterday, I was so confident about this med.
Posted by sigismund on November 9, 2010, at 22:53:03
In reply to Day 1 on ago, posted by orbital on November 9, 2010, at 20:01:38
How much did you take?
I assume you took 25mg.
That is too much initially. At least it was for me.
You could try taking 12.5mg when you feel up to it.
Posted by orbital on November 10, 2010, at 0:59:18
In reply to Re: Day 1 on ago » orbital, posted by sigismund on November 9, 2010, at 22:53:03
Thanks for the advice, Sigismund.. It does sound obvious now (titrating slowly) but it never occurred to me. In fact my doc mentioned going up to 50 mg in a week.
I might try this again in a few days, at 12.5 or even 6mg, as I really want to give this med a fair trial, but right now I feel terrible - very anxious and zoned out. I had to take 4mg of Klonopin versus my usual 1-1.5mg dose.
Maybe agomelatine's "mild" side effects have been downplayed or -more likely- maybe its my individual biochemistry acting up. It's strange, as I'm usually able to take med side effects in stride, but I haven't felt this sick and out of it in a very long time.
Anyway, I really appreciate your advice, thank you :)
> How much did you take?
>
> I assume you took 25mg.
>
> That is too much initially. At least it was for me.
>
> You could try taking 12.5mg when you feel up to it.
Posted by ed_uk2010 on November 10, 2010, at 13:22:22
In reply to Re: Day 1 on ago » orbital, posted by sigismund on November 9, 2010, at 22:53:03
Hello Sigi,
In the long term, what dose of agomelatine do you believe has the best antidepressant effect?
Posted by sigismund on November 10, 2010, at 13:57:56
In reply to Re: Day 1 on ago » sigismund, posted by orbital on November 10, 2010, at 0:59:18
>In fact my doc mentioned going up to 50 mg in a week.
From my experience, crazy.
It took me maybe 2 months until there was no afternoon anxiety, and that was at 25.
Your body will likely end up needing quite enough of this chemical. There's no need to speed up the process, and it will be painful to do so.
If I was starting over again (and being me) I would stay on 12.5 for a month and then maybe 2/3 of a tablet for another month, and only then 1 a day.
I quite liked the initial effect of half a tablet a day. OTOH, if you are suffering from something you need to get rid of then this may not cut the mustard.
Posted by sigismund on November 10, 2010, at 14:03:08
In reply to Re: Day 1 on ago » sigismund, posted by ed_uk2010 on November 10, 2010, at 13:22:22
>In the long term, what dose of agomelatine do you believe has the best antidepressant effect?
Hello Eddy
Well,it might not be great for your liver (the liver enzyme thing) so that's one reason not to go to 50md/d.
It's crazy stuff to stick under your tongue. Hurts and burns and likely is the thing that causes the gastric irritation in some people. They are bringing out a sublingual dose of just a few milligrams. Last night I took the equivalent of 50, mainly because of a difficult day > drink in the evening > poor sleep (or so I theorise).
Posted by orbital on November 10, 2010, at 14:32:18
In reply to Day 1 on ago, posted by orbital on November 9, 2010, at 20:01:38
Okay, I bit the bullet and took my second dose (25mg) last night. I tried to follow Sigismund's advice to split the tab in half, but the first pill crumbled, so I wound up taking a whole one.
Non-eventful experience this time around. Slept pretty soundly and I woke up feeling much better (still hazy and a bit hungover, but not depressed nor anxious). Maybe the high dose of clonazepam I took yesterday smoothed things out a bit.
Today my doc told me that he was pretty sure that -going by other patients' experience- the side effects should hopefully lift soon, and to take clonazepam as needed in the meantime to ward off anxiety. I'm not too happy about this, I like to keep the Klonopin as low as possible, but I'm willing to do it.
He also ordered liver tests, and told me I'd have to repeat them in 6-8 weeks, to be on the safe side.
His theory is that my Paxil-Valdoxan combos could potentially work very well (he has several patients on agomelatine + SSRI, but I'm his first Paxil-ago guy)
The jury is still out of course, but barring any further nasty side effects, I'll keep taking the ago.
If anyone is interested, I'll keep updating.
Posted by orbital on November 10, 2010, at 14:37:07
In reply to Re: Day 1 on ago » orbital, posted by sigismund on November 10, 2010, at 13:57:56
Hey Sig, I'm wondering about this:
> Your body will likely end up needing quite enough of this chemical.
What do you mean by this? Have you noticed an increased response to a higher agomelatine dose? What's it like?
Thanks! :)
Posted by ed_uk2010 on November 10, 2010, at 14:49:05
In reply to Re: Day 1 on ago » ed_uk2010, posted by sigismund on November 10, 2010, at 14:03:08
>It's crazy stuff to stick under your tongue.
But Valdoxan are not sublingual tablets, you're just supposed to swallow them. Why do you put them under your tongue Sigi?
Posted by sigismund on November 11, 2010, at 1:04:22
In reply to Re: Day 1 on ago » sigismund, posted by orbital on November 10, 2010, at 14:37:07
>> Your body will likely end up needing quite enough of this chemical.
>What do you mean by this?
When I look back I realise I could have saved myself some difficult afternoon anxiety if I had gone up more slowly. Eventually I had no problem taking high doses but why give yourself a hard time to get a tolerance?
>Have you noticed an increased response to a higher agomelatine dose?Not so much to higher doses as such, but yes, that too.
What I noticed was initially a calm nice feeling followed after some weeks by the afternoon anxiety which was quite unlike normal anxiety and was a product of the 5ht2c antagonism leading to higher NE maybe. This passed after maybe a month? I could have avoided the whole thing, I now realise.
Posted by sigismund on November 11, 2010, at 1:07:34
In reply to Re: Day 1 on ago, posted by ed_uk2010 on November 10, 2010, at 14:49:05
>Why do you put them under your tongue Sigi?
We are encouraged by the popular culture to say 'because I can'.
Actually, I was curious. I take a lot of things under my tongue. I like to taste them. It helps me formulate an opinion.
Now it could be the excipients that do that, but if it is, it may be those which lead to the gastric irritation.
Posted by orbital on November 12, 2010, at 12:09:54
In reply to Day (night) 2, posted by orbital on November 10, 2010, at 14:32:18
Thought I'd update this thread. Agomelatine 25mg - side effects seem to have subsided quite a bit. Anxiety is down, sleep is okay. I'm getting flu-like symptoms now though: very stuffy nose, bad cough, no fever- not sure if it's the ago, though.
So far so good, I'll stick to it for a few weeks.
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