Agomelatine/Valdoxan

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Hi. I have fought hard to have agomelatine prescribed (currently privately, thanks to NICE guidance which is being changed again next month). I had it prescribed several years ago for anxiety and OCD/phobic disorder until NICE put an embargo on it on the grounds of cost). I have tried several SSRIs in the meantime but with no success and a LOT of illness. Agomelatine has definitely brought some improvement to my anxiety and my depression has virtually gone. BUT I am experiencing side effects and I'd be interested to know what other people have experienced.

1. Sleep

2. Digestion

3. Muscular pain

Any comments would be appreciated.

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10 Replies

  • Posted

    Hi Jan, I took Agmelatine privately several years ago my Psychiatrist put me on 50mg  fairly quickly as I was suffering quite severe depression. I found it to be the fastest and possibly most effecous antidepressants I've ever tried BUT I had major problems with anxiety on it. I found despite Agomelatines reputation for being helpful with insomnia it actually created insomnia, I struggled to get to sleep at all and woke very early feeling jittery. I had almost constant anxiety, feelings restlessness and the muscular pain you mention - particularly through my back but my whole body felt achy ... I did have a lot of upper gastric discomfort, indigestion, dispepsia type symptoms and diarrhoea too but I have Crohn's diseas so not sure if I can give a fair view on this aspect. After a few months I had to stop taking the Agomelatine because I was so exhausted, burnt out and on the brink of hypermania. Really wish I could've hit some balance for these issues because as I say it was such a great antidepressant otherwise. Good luck xx

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    • Posted

      Thanks Sadly, that's helpful. I'm sorry it exacerbated your anxiety. I too am finding it has the reverse effect on my sleep - still awake at 2 or 3am, then restless, light sleep with exhausting technicolor dreams so I wake up (far too early) worn out! You describe the aches spot on too - I'm walking like an old lady and feel like I've arthritic hands and feet (I got this with mirtazapine too). I have no appetite and find food revolting but I don't actually experience nausea, just horrible dyspepsia. On the plus side, my anxiety is a bit better but not enough to give me the confidence to get out there and live! My depression is gone. When the sun comes out, I almost feel good. I so want this to work as I've run out of options and age will soon be a factor as I am in the 'elderly' group to my mortification and some meds can't be prescribed for old biddies.

      I'm having psychotherapy (CBT was useless for me) and trying to exercise despite the discomfort. Fingers crossed the symptoms ease. I'm on week 6 now, 25 mg.

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    • Posted

      Best of luck Jan! Maybe talk to your Consultant about adding something in alongside to help with sleep and maybe anxiety. Perhaps a small dose of sertraline? 

      I did two years of Psychotherapy - best thing I did for my PTSD ever! I did t get on with CBT either but can't praise Psychotherapy enough.

      i really do wish you well x

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    • Posted

      My dr has just refused me agomelarine as he says it has liver issues.  He is trying to,push antipsychotic augmentation and im sure its on cost grounds (nhs).  Mainly i have depression with anxiety, no bipolar so very unsure of his approach and attitude.  
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    • Posted

      Hi Ann, Agumelatine can cause liver toxicity so its procedural to have liver checks at initiation and at 3 months intervals fir some during treatment.

      Low dose antipsychotic augmentation can be very useful in treatment resistant depression - low dose antipsychotic  like quitiapine are often used in acute psychiatry with good results for both depression and anxiety. Good luck. X

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  • Posted

    Thanks for letting me know NICE guidelines changing next month. I hope that applies in Scotland. I am very unhappy psych has refused me this to try on grounds of liver toxicity.  Meanwhile imhave to try to use mirtazapine which is only partly helpful.  Did you think agomelatine helped anxiety? I am having to take diazepam to keep it down and dont want to continue that.
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    • Posted

      Hi Ann. Fortunately I copied the relevant document and saved it - otherwise I would think I had imagined it. It was "Depression - agomelatine (terminated appraisal): appendix A - RPP decision paper - May 2015" and it says : 'the termination advice in TA231 will be updated and superseded by any subsequent recommendations on the use of agomelatine in the clinical guideline, which is due to be published in May 2017. At this point, TA231 will be withdrawn.'

      I used this as evidence to my GP and then (sadly, private) psychiatrist because Agomelatine had worked well for me and has far fewer side effects. Currently it is red-flagged by my NHS Trust, so can only be prescribed by a hospital, hence needing to see a psychiatrist privately and pay for the prescription until the new guidance comes out. However, it works out cheaper than a coffee or half a pint a day!

      The original decision against agomelatine (TA231) was that it offered nothing different (fewer side effects didn't count) from other SSRIs and cost couldn't be justified. It will now be included in the new clinical guidance on depression, May 2017, at which point Trusts will then have to revise their guidelines so it will be a while before it is as easily prescribed as other meds.

      As regards the liver toxicity issue, unless you have liver problems, it is unlikely to matter, any more than links to other dire effects they use to scare us off. I am having a liver function test, pre-prescription, week 3, week 6, week 12.... Your psych may be thinking cost? It's way cheaper than a lot of illness-specific drugs they prescribe every day!

      My psychiatrist also persuaded me to try mirtazapine. I had 4 weeks of what he called 'placebo response' and then became a zombie with severe muscular pain. I had to come off it and that in itself was a horrid process which actually kept me in bed for days. My advice would be, if you do stop mirtazapine, to do so very very slowly, over many weeks, not the suggested 2 week tapering.

      It's early days with the agomelatine. My anxiety is noticeably easier but is not gone like the depression. But anxiety has been a major factor in my life, unlike the relatively new depression, so maybe that's why. Meantime, I continue to use diazepam on an ad hoc basis, as need arises. Diazepam is far more 'dangerous' than agomelatine and my GP is reluctant to prescribe it. In addition, I am receiving long-term psychotherapy (CBT was pointless) and can now get back to exercise so all I need to sort out is my poor appetite to get an all-round approach to managing a lifelong horror!

      Good luck. I have found that, if you present the documentation and show you know what you are doing and accept it may not work, psychs are more willing to listen. We are individuals. What works for one might not work for another but we know ourselves better than a psych does - they just see a set of symptoms, not individual experience and pain. If I hear the word 'evidence' once more, I think I might crack! Grrr. 

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    • Posted

      Thank  you for such an enlightening piece of great information.

      You have given me food for thought and i wll be looking up all the evidence i can find from NICE  before my next appointment, not for a while yet, but will take it along.

      Meanwhile i continue on the lowest dose mirtazapine (aching back, legs etc), and i have a cbt appt with clinical psychologist in two weeks so will ask if i can have psychotherapy instead of CBT which is doing nothing(private again!)

      Your advice is so very welcome and helpful, i hope your journey with agomelatine goes smoothly, please keep in touch.

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  • Posted

    Hi jan

    On the one hand, I'm sorry to say that my experience matches yours with valdoxan. I'm in Australia where valdoxan is available however not on the equivalent of your NHS, however if it worked I'd have no problem with the cost.

    I was put onto 50mg quite quickly by my psychiatrist and although it did work well for my MDD major depressive disorder, I have found the side effects to be exactly as you've described.

    I get particularly annoyed at my psych because I have the impression that despite seeing him regularly for over 17 years I still don't think he believes me when I describe the side effects.

    Far from giving me a good night's sleep, valdoxan (even after 5 months, now back down to 25mg) still has me waking in the middle of a bad, vivid dream very early in the morning and unable to go back to sleep.

    But by far the worst effect is the muscular pain in my back, and general muscle cramping in legs/arms/hands/feet etc. I think the next person who tells me to hydrate properly, or take magnesium, or not drink alcohol (at all), etc etc will get very short shrift from me.

    After this amount of time, I'm convinced its the valdoxan that's causing these issues.

    It DOES NOT give me hours of wonderful deep sleep, quite the opposite. I wake up as stiff as a surfboard, feeling like crap, and there are days when I just go straight to the cupboard for paracetomol and coffee at anywhere from 2 to 4am.

    Having said that, and putting the muscular pain/cramps aside, after a while and generally for the rest of the day my depression is non-existent.

    I have kept taking it for this long simply because my son just got married and I didnt want to make any changes before that was done and dusted. Problem is, I've tried just about all the ssri's, tricyclics and maoi's plus ECT and none has been lasting.

    My biggest wonder is the dreams I have with valdoxan - they are vivid, and all about issues in the past that I can regularly put aside with CBT and conscious effort during the day - but have no control when they come back at night!!!! My psch says its because of the effect those events had on me at the time, but that's no help. I'm trying to move on and have done everything the medical profession has asked me to do.

    The muscle pain/cramping has been so bad I've given up my one pastime (golf) and I see no option but to discontinue the valdoxan soon and move back onto a maoi, with all the dietary restrictions that entails.

    Sorry to be such a downer. I honestly believe that most of the time I can get better results by self-medicating with alcohol and using valium as needed.

    It's a mystery to me why all anti-depressants are such ineffective medications; nobody has all these side effects with statins, for example - and it's almost impossible to get a psychiatrist to take you seriously when you say I have back pain that wasn't there before I started taking your latest poison .......................

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