![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
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.
Posted by sigismund on November 12, 2010, at 13:25:29
In reply to Days 3-4, posted by orbital on November 12, 2010, at 12:09:54
>very stuffy nose,
Well, it's not impossible.
I react to heaps of things and after taking ago I notice increased mucous production.
Posted by orbital on November 12, 2010, at 19:21:11
In reply to Re: Days 3-4, posted by sigismund on November 12, 2010, at 13:25:29
Interesting, Sig, you too?
I've just checked the package insert, "flu-like symptoms" and "nasopharyngitis (common cold)" are reported side effects (2.5% and 3% respectively). They are a bit annoying, but so far I'm impressed by Valdoxan's tolerability. Waiting for my first round of liver panel results.
Take care :)
> >very stuffy nose,
>
> Well, it's not impossible.
>
> I react to heaps of things and after taking ago I notice increased mucous production.
Posted by orbital on November 16, 2010, at 11:27:29
In reply to Re: Days 3-4 » sigismund, posted by orbital on November 12, 2010, at 19:21:11
One week into Valdoxan, I must say I'm impressed so far.
As an hypnotic, it's working really well, definitely better than anything else I've tried. The quality of my sleep is about the same, but I do get a solid 8 hours. What I really like is how awake and alert I feel during the day.
I've also noticed that I feel very "relaxed" - not apathetic or dumbed down, but at ease.
If this trend continues, I'll consider going off Paxil to see how agomelatine works on its own. So far so good.
Posted by Tomatheus on November 16, 2010, at 12:07:48
In reply to 7 days, posted by orbital on November 16, 2010, at 11:27:29
Oribtal,
It's great to hear that Valdoxan has been working well for you so far. Please continue to keep us posted on your progress.
Tomatheus
Posted by morgan miller on November 16, 2010, at 13:26:00
In reply to 7 days, posted by orbital on November 16, 2010, at 11:27:29
>If this trend continues, I'll consider going off Paxil to see how agomelatine works on its own. So far so good.
Are you concerned that there is some synergy here and you may not feel as well on Paxil? I'm always worried that if drugs like SSRIs work and I stop them, they may not work as well when I try to get back on them. If you don't have any unwanted side effects from Paxil, I would not get off it.
I'm guessing Paxil has given you the most benefit of all the SSRIs and you have given them all a good shot.
Posted by orbital on November 16, 2010, at 20:06:41
In reply to Re: 7 days, posted by morgan miller on November 16, 2010, at 13:26:00
> >If this trend continues, I'll consider going off Paxil to see how agomelatine works on its own. So far so good.
>
> Are you concerned that there is some synergy here and you may not feel as well on Paxil? I'm always worried that if drugs like SSRIs work and I stop them, they may not work as well when I try to get back on them. If you don't have any unwanted side effects from Paxil, I would not get off it.
>
> I'm guessing Paxil has given you the most benefit of all the SSRIs and you have given them all a good shot.
>Well, actually I'm thinking about the flipside: what if Paxil is hampering the agomelatine?
I have no reason to suspect this might be the case, but at some point I'd like to try Valdoxan on its own.
About meds not working the second time around... my old doc told me that the brain's biochemistry changes over time (for better or worse this is the long term aim of pharmacotherapy of course) so certain meds may "feel" different when rechallenged. For instance, several years ago I was on bupropion for a good 8 months with little to no problems; when I tried it again last year, I was unable to tolerate it. Doc's theory being, it's not the med itself that has changed, but the person's biochemical makeup.
Anyway, of all the SRIs, Paxil is a fair middle ground for me: no noteworthy side effects, and reasonably effective for both depression and anxiety.
Posted by sigismund on November 17, 2010, at 12:52:03
In reply to 7 days, posted by orbital on November 16, 2010, at 11:27:29
>As an hypnotic, it's working really well, definitely better than anything else I've tried. The quality of my sleep is about the same, but I do get a solid 8 hours. What I really like is how awake and alert I feel during the day.
>I've also noticed that I feel very "relaxed" - not apathetic or dumbed down, but at ease.
That was exactly my experience.
Posted by morgan miller on November 19, 2010, at 22:47:17
In reply to Re: 7 days » morgan miller, posted by orbital on November 16, 2010, at 20:06:41
>Doc's theory being, it's not the med itself that has changed, but the person's biochemical makeup.
Well that's obvious. I believe it is possible that getting off the medication allows for certain changes to take place, and when the medication is reintroduced, it does not work the same way.
I was just saying, if you end up feeling pretty good while on valdoxan and paxil, why mess with that?
>Anyway, of all the SRIs, Paxil is a fair middle ground for me: no noteworthy side effects, and reasonably effective for both depression and anxiety.
You're fairly lucky in this regard. So I guess you had a specific reason for choosing Paxil over Zoloft, Lexapro, or Prozac.
Posted by Conundrum on November 20, 2010, at 10:37:15
In reply to Re: 7 days, posted by morgan miller on November 16, 2010, at 13:26:00
I tend to think there might be a synergy going on when you combine 5 HT2C antagonism and serotonin reuptake inhibition. Taking low dose prozac does both and gets me motivated. Taking remeron does the antagonism but poops out for me. I think the 5 HT1A activation, and perhaps some of the other serotonergic receptors getting hit, helps increase the norepinephrine and dopamine disinhibition of
5 HT2C antagonism and keeps it from pooping out perhaps.> >If this trend continues, I'll consider going off Paxil to see how agomelatine works on its own. So far so good.
>
> Are you concerned that there is some synergy here and you may not feel as well on Paxil? I'm always worried that if drugs like SSRIs work and I stop them, they may not work as well when I try to get back on them. If you don't have any unwanted side effects from Paxil, I would not get off it.
>
> I'm guessing Paxil has given you the most benefit of all the SSRIs and you have given them all a good shot.
>
>
Posted by orbital on November 26, 2010, at 12:54:18
In reply to Re: 7 days, posted by morgan miller on November 19, 2010, at 22:47:17
The flu-like symptoms got really out of control and bothersome - I felt like I had the cold from h*ll, couldn't breathe properly due to mucus, pain in my chest etc (no hives, no fever though).
My doc did some tests and ruled out infection. He told me to stop Valdoxan for a while, to see if the symptoms lifted, as these symptoms are documented side effects.
This was 10 days ago. I do feel better, so I'm restarting ago tonight. Doc told me to hang in there if the symptoms reappear, as they might abate over time.
On the bright side of things, my liver panel came back just fine - better than it was a year ago, actually.
Anyway, I'm hoping it was just a cold.
Posted by orbital on November 26, 2010, at 12:54:53
In reply to Re: 7 days, posted by Conundrum on November 20, 2010, at 10:37:15
Posted by morgan miller on November 26, 2010, at 21:19:15
In reply to Starting over, posted by orbital on November 26, 2010, at 12:54:18
Good luck! Keep us posted.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.