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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by hansi555 on January 27, 2011, at 4:16:38
Hi all
I just started up Valdoxan 25 mg 2 days ago and I am feeling extremely tired when waking up. Is this normal and will it go away sometime soon? I also have a lot of dreaming going on, especially the last couple of hours before getting up.
I am also on 75 mg Noritren and a 1/4 of a sleeping pill. I take 50 mg together with the Valdoxan and 25 mg in the morning.
Posted by SLS on January 27, 2011, at 4:57:59
In reply to Valdoxan experience, posted by hansi555 on January 27, 2011, at 4:16:38
> Hi all
>
> I just started up Valdoxan 25 mg 2 days ago and I am feeling extremely tired when waking up. Is this normal and will it go away sometime soon? I also have a lot of dreaming going on, especially the last couple of hours before getting up.
>
> I am also on 75 mg Noritren and a 1/4 of a sleeping pill. I take 50 mg together with the Valdoxan and 25 mg in the morning.My first few nights during Valdoxan treatment were comprised of frequent awakenings and vivid dreaming. These things subsided with continued treatment.
Good luck.
- Scott
Posted by Phillipa on January 27, 2011, at 11:22:34
In reply to Re: Valdoxan experience » hansi555, posted by SLS on January 27, 2011, at 4:57:59
This kind of reminds me of when EMSAM came out. Hoping this med is all I've read it is. Good luck Hansi. Phillipa
Posted by hansi555 on January 28, 2011, at 5:16:54
In reply to Re: Valdoxan experience » hansi555, posted by SLS on January 27, 2011, at 4:57:59
After my 3rd pill of Valdoxan I cant say my depression has improved, on the contrary I have had crying spells both yesterday and this morning also.
I know I am supposed to wait for longer before judging but I am wondering how many days I should give this drug a chance?
Previously I was on 75 mg Nortriptyline and 3,75 mg Mirtazapin and doing okay, now I have skipped the Mirtazapin and replaced it by 25 mg Valdoxan.
Any thoughts?
> > Hi all
> >
> > I just started up Valdoxan 25 mg 2 days ago and I am feeling extremely tired when waking up. Is this normal and will it go away sometime soon? I also have a lot of dreaming going on, especially the last couple of hours before getting up.
> >
> > I am also on 75 mg Noritren and a 1/4 of a sleeping pill. I take 50 mg together with the Valdoxan and 25 mg in the morning.
>
> My first few nights during Valdoxan treatment were comprised of frequent awakenings and vivid dreaming. These things subsided with continued treatment.
>
> Good luck.
>
>
> - Scott
Posted by SLS on January 28, 2011, at 5:34:01
In reply to UPDATE: Re: Valdoxan experience, posted by hansi555 on January 28, 2011, at 5:16:54
Your changes in mood might be a sign that your brain is changing in a good way. Being weepy can indicate a return of more robust emotions. That you experienced a temporary improvement is a good sign. The ascent through the darkness of depression is not always a steady climb. You will likely have what I call "retreats" in which a worsening of depression occurs occasionally, even though the trend toward improvement over time is obvious.
Time: 2 weeks minimum at 12.5 - 25mg. I would certainly continue for at least 4 weeks as long as you are tolerating the drug.
Add back nortriptyline if there is a hint of improvement on Valdoxan alone.
I look forward to seeing good things from you.
- Scott
Posted by hansi555 on January 28, 2011, at 5:43:00
In reply to Re: UPDATE: Re: Valdoxan experience » hansi555, posted by SLS on January 28, 2011, at 5:34:01
Thanks SLS
What do you mean by this:
> Add back nortriptyline if there is a hint of improvement on Valdoxan alone.Would you remove Nortriptyline? I am now taking 75 mg Nort together with the 25 mg Valdoxan. This is the way my p-doc always do, overlapping.
Please bear with me, I am not stupid, I am just not sure what you mean by " Add back"...
> Your changes in mood might be a sign that your brain is changing in a good way. Being weepy can indicate a return of more robust emotions. That you experienced a temporary improvement is a good sign. The ascent through the darkness of depression is not always a steady climb. You will likely have what I call "retreats" in which a worsening of depression occurs occasionally, even though the trend toward improvement over time is obvious.
>
> Time: 2 weeks minimum at 12.5 - 25mg. I would certainly continue for at least 4 weeks as long as you are tolerating the drug.
>
> Add back nortriptyline if there is a hint of improvement on Valdoxan alone.
>
> I look forward to seeing good things from you.
>
>
> - Scott
Posted by phillipa on January 28, 2011, at 20:39:58
In reply to Re: UPDATE: Re: Valdoxan experience, posted by hansi555 on January 28, 2011, at 5:43:00
Hansi sounds like Scott doesn't think you are on nortrip anymore? Phillipa
Posted by SLS on January 28, 2011, at 20:59:13
In reply to Re: UPDATE: Re: Valdoxan experience, posted by hansi555 on January 28, 2011, at 5:43:00
Hi.
> What do you mean by this:
>
> > Add back nortriptyline if there is a hint of improvement on Valdoxan alone.> Would you remove Nortriptyline? I am now taking 75 mg Nort together with the 25 mg Valdoxan. This is the way my p-doc always do, overlapping.
I apologize. I did not read the entire thread to see that you were already taking nortriptyline.
> Please bear with me, I am not stupid,
But I am...
:-)
Sorry for the confusion.
- Scott
Posted by hansi555 on January 29, 2011, at 3:49:21
In reply to Re: UPDATE: Re: Valdoxan experience, posted by SLS on January 28, 2011, at 20:59:13
Well, I dont know if I dare stop taking Nort to see if Valdoxan would work on its own but I guess it is the only way to find out.
I have also been on sleeping pills for seven weeks now and I chose to start up Valdoxan to see if this would
a) improve the AD effect overall (75 mg Nort is maybe to little)
b) make the need for sleeping pills go awayI am suffering from my second stress released depression, the first was 3 years ago. I have not been working for 6 weeks now but I hope to return some time in the spring when I am well enough.
> Hi.
>
> > What do you mean by this:
> >
> > > Add back nortriptyline if there is a hint of improvement on Valdoxan alone.
>
> > Would you remove Nortriptyline? I am now taking 75 mg Nort together with the 25 mg Valdoxan. This is the way my p-doc always do, overlapping.
>
> I apologize. I did not read the entire thread to see that you were already taking nortriptyline.
>
> > Please bear with me, I am not stupid,
>
> But I am...
>
> :-)
>
> Sorry for the confusion.
>
>
> - Scott
Posted by SLS on January 29, 2011, at 6:09:29
In reply to Re: UPDATE: Re: Valdoxan experience, posted by hansi555 on January 29, 2011, at 3:49:21
> (75 mg Nort is maybe to little)
There is an easy way to find out. Get a simple blood test, and raise the dosage until the drug blood concentration falls no lower than 1/2 of the recommended concentration range: 50 to 150 ng/ml. I don't think you should stop titrating until you at least reach 100 ng/ml. If taking both Valdoxan and nortriptyline is being tolerated, I don't understand why you would want to make a monotherapeutic switch instead of developing a polypharmaceutical approach.
- Scott
Posted by hansi555 on January 29, 2011, at 8:35:56
In reply to Re: UPDATE: Re: Valdoxan experience » hansi555, posted by SLS on January 29, 2011, at 6:09:29
Okay, I can see I am not being very clear. So here is my story:
After 2,5 years treatment where of the last year was w. 110 mg Nort, 10 mg Lexapro and 12 mg Mirtazapin, I found my self in state of okay but still w ups and downs. The effect and my general mood was not in balance with the costs of the SEs, so I decided to try and taper off over a half year period.
As my first episode was due to stress released unipolar depression, I thought it fair to give a non-medication period a fair chance.I prepared myself, my family, friends and workplace for the worst but actually it went very well the first 18 weeks and even with some minor down periods, I could say for sure that those 18 weeks were far better than the 18 weeks before starting the taper. At week 18 into the taper I was on 70 mg Nort and 7,5 mg Mirt, the Lexapro was the first I removed.
And because it all went so well my level of activities got higher on work and in my spare time and eventually some stress symptoms like dizziness showed. I ask my psycologist if one could get depressed of doing too many things and she said "no" and together we agreed that it could be the taper causing these symptoms. Big mistake. As the taper continued, the stress symptoms came and went but being the person I am, I just wanted to finish the taper as I thought the dizziness etc. would dissapear.At the very end of the taper (week 26, at the end of November), I began having trouble to sleep and eventually I broke down and had to leave my work place on the 10th of December.
At the beginning I hoped to stay off the drugs - or at a minimum - and be well on a cocktail of alternative methods such as running every day, relaxing, more therapy. At this point in time it was not clear if it was "only" stress or also depression but along December it came creeping and I have been home from work since then.
My psycologist threw the towel 4 weeks ago and I started on the cocktail that had worked during the taper, hoping this was going to work.As I dont really like way Lexapro made me feel and since I have heard a lot good too about Valdoxan I decided to add this. Also I have been on 1/2 sleeping pill (of one Imozop 7,5 mg) which I hoped too get rid of soon.
I know from earlier that I can increase the level of Nort by taking Lexapro and Mirtz without having too many SE from the Nort, my blood levels were something like 70 ng/mL (or approx. 300 nmol/L.
I am going to my pdoc for the first time during this new episode next wednesday. I have talked w him over the phone a couple of times and he is not too keen on going upp in dosages, he wants to take samples along the way.
Back to your question: No, I am not against more drugs at the same time but I do think that it is possible to later go off the meds or at least to a lower dosage IF I can manged to live my life in another way.
I am SO disapointed that the taper ended in stress and a new depressive episode, troublesome for my wife and kids, away from job again, feeling like sh*t most of the time (you know the drill). Mostly I am disapointed with myself but also that my psycologist didnt council me better. The stress symptoms were evident for many of the last 10 weeks before the break down.
I should have stopped the taper at that point and listened to the stress signals - instead I sort of copied my first episode 3 years ago and blaimed the lack of medicine in my body, soo foolish...> > (75 mg Nort is maybe to little)
>
> There is an easy way to find out. Get a simple blood test, and raise the dosage until the drug blood concentration falls no lower than 1/2 of the recommended concentration range: 50 to 150 ng/ml. I don't think you should stop titrating until you at least reach 100 ng/ml. If taking both Valdoxan and nortriptyline is being tolerated, I don't understand why you would want to make a monotherapeutic switch instead of developing a polypharmaceutical approach.
>
>
> - Scott
Posted by bodhisattva_guy on February 5, 2011, at 2:14:12
In reply to UPDATE: The whole Story (Valdoxan experience), posted by hansi555 on January 29, 2011, at 8:35:56
I have never heard of this medication, looking it up it seems that in a year it might be available in US. So I assume I am not alone, and would like to detail this med:
Agomelatine (trade names Valdoxan, Melitor, Thymanax) is an antidepressant developed by the pharmaceutical company Servier. It is marketed for the treatment of major depressive disorder and has been reported to have a reduced level of sexual side effects as well as discontinuation effects compared to some other antidepressants. Agomelatine may also have positive effects on sleep....It increases noradrenaline and dopamine release specifically in the frontal cortex and has no influence on the extracellular levels of serotonin. Agomelatine has shown an antidepressant-like effect in animal models of depression (learned helplessness test, despair test, chronic mild stress) as well as in models with circadian rhythm desynchronisation and in models related to stress and anxiety. In humans, agomelatine has positive phase shifting properties; it induces a phase advance of sleep, body temperature decline and melatonin onset.[2]
http://en.wikipedia.org/wiki/Agomelatine
Suggestion: please use generic name - as it is likely that this medication will be called somewhat differently when introduced in the US.
Agomelatine is a melatonergic agonist (MT1 and MT2 receptors) and 5-HT2C antagonist. Binding studies indicate that it has no effect on monoamine uptake and no affinity for α, β adrenergic, histaminergic, cholinergic, dopaminergic and benzodiazepine receptors.[2]"Agomelatine was discovered and developed by the European pharmaceutical company Servier Laboratories Ltd. Servier continued to develop the drug and conduct phase III trials in the European Union. In March 2005 Servier submitted agomelatine to the European Medicines Agency (EMEA) under the trade names Valdoxan and Thymanax.[3] On 27 July 2006 the Committee for Medical Products for Human Use (CHMP) of the EMEA recommended a refusal of the marketing authorisation of Valdoxan/Thymanax (agomelatine). The major concern was that efficacy had not been sufficiently shown. The CHMP had no special concerns about side effects.[3] In September 2007, Servier submitted a new marketing application for Valdoxan (agomelatine) to the EMEA.[4] On 20 November 2008, Valdoxan was given a positive opinion, with restrictions,[5] by the EMEA,[4] and was subsequently given marketing authorisation in the European Union on 20 February 2009.[6] Release dates in the individual countries of the EU were dependent on marketing arrangements.
In March 2006, Servier announced it had sold the rights to market agomelatine in the United States to Novartis.[7] It is currently undergoing phase III clinical trials in the US. Novartis lists the drug as scheduled for submission to the FDA no earlier than 2012.[8] It is currently sold in Australia under the Valdoxan trade name."
This is the end of the thread.
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