How is Agomelatine different from other Antidepressants? | A Psychiatrist Explains | Dr Rege
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- Опубликовано: 9 апр 2022
- Agomelatine, also known as Valdoxan, is a novel and atypical antidepressant that acts as a melatonergic antidepressant and has a distinctly favourable side effect profile. Dr Sanil Rege, Consultant Psychiatrist, explains its mechanism of action.
#agomelatine #valdoxan #antidepressants
Agomelatine is a melatonin receptor agonist (M1 & M2) and a serotonin 5 HT2C receptor antagonist with a favourable side effect profile. There is a lack of sexual dysfunction, sleep benefits, and no discontinuation symptoms - all of which confer valuable clinical benefits in the treatment of depression.
Hyperactivity of the 5-HT2C receptors may contribute to the symptoms of MDD, and agomelatine-induced 5-HT2C antagonism has been shown to increase the release of dopamine and norepinephrine in the frontal cortex.
Agomelatine is evidence-based in the treatment of depression, anxiety, OCD and bipolar depression.
Read more on agomelatine: psychscenehub.com/psychinsigh...
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SUCH a clear video. Thank you. What sets this drug apart from SSRIs and SNRIs is no suppressing of REM sleep, so important for people with DSPS, and for anyone with depression/anxiety caused by childhood trauma where they get nightmares and insomnia
Yes very good point . With regards to trauma nightmares because NA neurons are highly concentrated on the amygdala - using alpha 2 agonists e.g clonidine or alpha 1 antagonist can be an effective strategy as well . We have done a video on that as well
Excellent! You answered nearly all my questions. Thank you
Thank you for your feedback.
Great video sir. I took SNRI's and SSRI's over a decade ago, moving from one miserable set of side effects to another, and this is the first drug that actually makes me think it could help. Thanks for the explanation.
What "miserable side effects" are you referring to?
This sounds so promising over what has been available!! Thank you!!!
It is a good agent with good efficacy and tolerability profile. Efficacious for the mild- mod depression when medication is needed and for anxiety.
@@PsychiatrySimplified, I’m so happy to know this. I checked to see it’s availability in the US and it doesn’t look like it’s here yet. Such a smart idea to help the frontal cortex which seems more diminished with other agents! And without a major list of untoward events too! I’m so grateful to learn about this!
Wish there was more long term data on Agomelatine
Great and beneficial video. Thanks Dr.
Glad it was helpful!
FANTASTIC video, I just got prescribed it for (anxiet, overthinking, insomnia, and my side notes was adhd) this video I looked at after google told me side affects of anxiety and insomnia, now how does that make sense, this video I even showed my mum we both think this video is super clear, concise and hits every point I didn't know this could treat adhd but I am excited for the 2 week mark 😀 I feel great so far, doc said 2 weeks for it to take affect, I'm 1 week in (I also blame placebo) due to it 'working' in 1 day
Thank you for your feedback. Also it's more than placebo as most individuals will describe ‘ things seem so different ‘ or I can think clearer for the first time in y life’ or I don't feel like I need to keep doing something all the time’. Yes agomelatine can help with adhd. Wish you well with your health.
Aussie mum here, v happy to hear. Took a full 15 mins to get GP to prescribe this (over fluoxetine) for my almost-16 yr old. She did liver function test first, and we will wait until after exams to start. All the drawbacks of SSRIs especially messing with REM sleep, make it worth the cost (not on PBS as you know).
The go-to for higher acuity adolescents with MDD and suicidality seems to be escitalopram not fluoxetine by the way. I mean child and adolescent psychiatrists’ go-to. Adult psychiatrists (in NSW!) are still in fluoxetine default mode. When confronted with an insomniac teenager who needs an energising SSRI like a hole in the head, they don’t consider agomelatine, they’ll just prescribe an olanzapine chaser with the fluoxetine 🤦🏽♀️@@PsychiatrySimplified
@@aleanbh3808 usually it’s because of the guidelines. Agomelatine is a more tolerable agent with a better side effect profile - but because data is limited compared to existing medications in adolescents often one defers to guidelines . Understand your point; Agomelatine is a tolerable agent that has sleep benefits and promotes dopamine and NA in frontal lobe helping with the activity and cognition components of depression. Wish your family well
Thank you very mutch Dr Sanil ❤🙏👍
Pleasure
Such an informative video, thank you
Thanks you for your feedback 🙏🏻
Thanks very much mate for a simple breakdown of this medication, it’s my first week on Agomelatine for my depression so let’s hope it works
hi did it help?
Did it help?
Is it working for you mate?
@@djp3819 yeah it is :))) it’s definitely help regulate my body clock and I’m having no where near as much day time sleeping, overall pretty good
Please make a video on Vortioxetine. All your videos are very informative Sir.
Will add to the list as well. Thank you for your feedback 🙏🏼
Thank you agreat video
I’m on this and have had much less issues with depression
Good to know. Thanks for sharing.
Love this! Have you had any other side effects I have been prescribed this never taken anything before. Do you feeel like you have more energy and zest for life ?
In the United States, it has not been approved. Apparently from what I've read, the trial results were nonsignificant and there are severe liver concerns.
The liver concerns in clinical practice are negligible. The tests are to be monitored at 3, 6, 12 and 24 weeks. It's efficacious in the mild- moderate depression and anxiety as well. It has a good tolerability profile. Also used as an augmentation agent in tertiary psychiatric practice ( when moderate depression does not respond to first line). Good agent overall. You can read more details here 👉psychscenehub.com/psychinsights/agomelatine-mechanism-action/#:~:text=Agomelatine%20is%20a%20melatonin%20receptor,treatment%20of%20depression%20%5B2%5D.
Dr Rege, have you done a video on Mianserin? I found this drug really improved my sleep.
Thanks for letting us know. Not so much as Mirtazapine is generally used instead - and also agranulocytosis is a risk. But yes it is as useful medication to consider . Thank you for the comment
Thank you for such an informative video. I would like to know if Valdoxan helps with pmdd symtoms.
I've been on Prozac and pristiq.
I'm currently stopping it now. But the withdrawls atee horrible.
My doctor is considering trying this next. Is this a medication I could use for half my cycle for pmdd?
It can be used but depends on symptoms to be targeted. In psychiatry , medication is used based on mechanisms to target symptoms. With PMDD you can read in more detail. psychscenehub.com/psychinsights/diagnosis-and-management-of-premenstrual-syndrome-premenstrual-dysphoric-disorder/
Thank you for your informative videos. I personally like the way you explain how antidepressants work.
Have few questions and would appreciate your personal feedback.
A) Can this be a good choice as a first line treatment for mild to moderate GAD or depression? or this is reserved for major or sever disorders?
B) How long (in weeks) usually does it take for Valdoxan to reach its peak of effectiveness?
C) if insomnia is experienced while on Valdoxan, how is it usually tackled and resolved?
D) Does the fact “that patient needs liver monitoring” mean it may impair a healthy liver? or this is for patient with already existing liver issues?
F) In terms of efficacy for GAD, which is better SSRI or Valdoxan?
Good questions. PS - This is general and not advice.
A. Can this be a good choice as a first line treatment for mild to moderate GAD or depression? or this is reserved for major or sever disorders? - Yes it is evidenced-based for mild to moderate GAD or depression. while it is also prescribed for MDD - at severe end of the spectrum other agents may be needed. You may look at the video we did on melancholic and psychotic depression which is severe depression.
B) How long (in weeks) usually does it take for Valdoxan to reach its peak of effectiveness? - usually, 2-3 weeks is sufficient for an initial response. Dose adjustment may be required thereafter.
C) if insomnia is experienced while on Valdoxan, how is it usually tackled and resolved? - Depends on type of insomnia. it may be transient - in which case subsides; in some, it may persist and be a side effect that may need a cessation of agomelatine (activation)
D) Does the fact “that patient needs liver monitoring” means it may impair a healthy liver? or this is for patients with already existing liver issues? This is a rare side effect. stopping medication results in liver tests being normalised in most cases. More information can be obtained from the package insert. recommendations are that medication needs to be ceased if LFTs and 3 times baseline.
F) In terms of efficacy for GAD, which is better SSRI or Valdoxan? Both are effective - this becomes a personal choice based on tolerability. Valdoxan has better tolerability. Valdoxan is considered if SSRIs do not work for GAD as third line (after SNRI or CBT) but some may choose valdoxan first line as it has better tolerability (better side effect profile than SSRIs)
Thanks for sharing your views.
I am interested in knowing more about how can Valdoxan be of help for those who suffer from anxiety and/or depression which impaired their sleep or caused them insomnia. Is insomnia alone as a side effect a valid reason to start considering a different option? Or is it worth for the patient to accept insomnia as price to pay for perhaps curing the cause (depression and/ anxiety) down the road? What’s the medical literature take on this?
Which brings me to another question, can low doses of sedative antidepressants such as of 7.5 mg mirtazapine, 10 mg amitriptyline etc. be used as adjunctive while on Valdoxan?
@@yuh-zeeds414 when insomnia is present this should be evaluated. Other causes such as obstructive sleep apnoea , mixed features ( racing thoughts etc) etc should be ruled out. In some cases augmentation strategies such as adding a small dose of sedative agent , Mirtazapine , clonidine is a valid strategy depending on symptoms being targeted. Other agents to treat insomnia can also be used - suvorexant , lemborexant can be used. Of course sleep hygiene and other strategies should be considered in addition
Well what about Tinnitus ringing in ears? And weight gain?
I took half a tablet 2 nights ago, and I was just knocked out. However, I didn't feel the side effects of ALL the other SNRIs/ SSRIs. However, my panic disorder was triggered. Is it possible the norepinephrine is triggering that? I am extremely sensitive on this level. I can't even drink decaf coffee.
Some individuals describe activating effects. In some cases these are short lived ; if persists that is a side effect. The antidepressant should always be matched with symptoms so discuss this with your doctor who will have a plan in relation to side effects and symptoms to be targeted. Wish you well.
Hi Dr Rege - currently on 25mg Metoprolol morning and evening for frequent ventricular ectopics (under the care of a Cardiologist). Are there any contra-indications or known drug interactions for taking this concurrently with Valdoxan?
In general there are no Cardiac issues with Agomelatine and is considered cardiac safe. But of course we can’t give advice so please discuss this with your doctor.
I have bipolar 2, I was prescribed 12.5mg of Valdoxan for my bipolar depression + 10mg of Abilify. It started well, felt a reduced symptoms of depression in the first 3 days but after a week, things took a turn for the worst, I felt really really down, suicidal thoughts. Could this be because I have yet to tritrate the dose to a therapeutic dose? Should I consider discussing this with my psych, Dr?
Yes it is appropriate for you to speak to your doctor. Often the education needs to be optimised over a period of time. Breakthrough symptoms are common place during early stages. Please contact your doctor urgently with thoughts you are having.
Appreciate the video. What's the best way to wean off 25mg Sertraline? Have taken for 18 months but have been recommended to switch to Agomelatine, harder than I expected.
I wonder if it can be taken simultaneously with Vyvanse or dexedrine and make it possible to lower the dose of those two medicines as well...
Theoretically it can be combined. However the doctor is in the best position to consider the rationale for augmentation. Augmentation is about achieving a balance between efficacy and tolerability by using the mechanisms of each medication
I got prescribed Agomelatine and it's working great. My sleep improved and my daytime anxiety reduced. After doing some research on the internet I came to know "Agomelatine is almost completely metabolized, with up to 80% of the dose excreted in the urine as non-active metabolites. Its median elimination half-life ranges between 1 and 2 hours."
Just curious to know if it eliminates that quickly then how it shows its 5-HT2C receptor antagonistic property in the daytime? I assume the 5-HT2C receptor antagonistic property is responsible for reducing anxiety. Thank you!
Excellent question. Rapid absorption - peak 2-3 hrs , half life 2 hrs approx wouid mean wash out 10 hrs - it increases DA and NA in the frontal cortex providing benefits for anxiety along with M1 & M2 . Essentially the rapid action means improved PFC control of amygdala. The peak is sufficient to lead to this action which is what studies show
@@PsychiatrySimplified Thank you for your quick and detailed reply :)
Any withdraw and side effects of this medicine ? Any benefit ? I used ssri but it has alot of side effects
I had an episode of MDD and now having some anxiety related issues how can I consult you, for telemedicine
If it blocks the 5HT2C receptor will it hinder the neurogenesis caused by classic ssris’s such as fluoxetine?
Neurogenesis is through the TRKB receptor which is the BDNF receptor. Many antidepressants act on this receptor which has been a recent discovery. In general 5HT2C antagonism improves PFC DA.
I'm on Valdoxan 25mg for 6 weeks because im diagnosed with GAD but I feel like it's keeping me awake at night now, no anxiety though 😅
Usually has a sleep improving effect in most but some can feel activated.
Important to rule out a ‘ switch ‘ -
Of course mentioning this to your doctor can.help with solutions
@@PsychiatrySimplified I am taking AgoMelatonin for like 4 years at the evening 50mg. But My question is. I feel better I would say and more calm after I took it. Is it possible to take AgOMelatonin via the daytime? I read one study about the flight attendant and she needs to take it through a crazy time schedule. So she took the same amount at 11pm. Because of the job day, she takes it in the daytime - different times and so on Based on the study she was doing fine. She wasnt sedated or something and she was capable of doing her job via daytime after the dosage with no problem and she was fine. Is it maybe for someone better to take it via daytime? And Sorry for my english
I was on valdoxan 25 mg ( sample given by my dr) for a month and by the end of the 30 days I found it great) but when I used my senior script was astounded it would cost Australian $80 for just 28 tablets there was a generic called Domion 25mg which costed A$55 which the Pharmacist assured me was the same thing. I’m on it a week and I’m back to the 3am wake up - is this just a mind over matter or -- should I stick with the original Valdoxan? Would appreciate your help
Anecdotally there are differences between responses of generic vs Valdoxan. Clinical response is the best gauge. Hope that helps
@@PsychiatrySimplified thank you for your response much appreciated
Thank you for this very informative video. I am currently tapering off Lexapro 20mg (escitalopram/lexam) by taking 10mg for two weeks, as instructed by my GP, and have started Domion 25mg just last night. I came here to find out if I still take my Melatonin homeopathic chewables and I'm glad I found your video. It looks like I don't need to take it with my bedtime Domion dose of 25mg. However I do wake up very groggy and I experienced light-headedness, dizziness, headaches and brain zaps along with cloudy vision at one point during the day. Is this from the tapering off of lexapro or from side effects of starting Domion - or both? Any advise? Thank you so much.
The brain zaps are indicative of a lexapro withdrawal. Taper should be gradual ( see the other video we have done on tapering) . Agomelatine with melatonin can lead to some grogginess . Even alone it can lead to some sedation but this should wane over a week or so. Ofcourse please discuss this with your doctor as the comments above are general only - not medical advice
@@PsychiatrySimplified take it at 8pm rather than later? (For a 15 year old)
@@aleanbh3808 generally it is taken an hour or so before bed. Having said that best to ask the doctor if any adjustments are to be made.
I have been out on straterra for newly diagnosed. ADHD I have been taking Agomelatine for years. Do you think I can stop the agomalatine now? It’s so expensive. Are they quite similar?
No they are different in their mechanisms. It would be inappropriate to advise medication changes on a forum. This should be dicussed with your doctor. Atomoxetine is NARI - so increases NA predominantly without any Melatonin agonist activity.
I take duloxetin, lamotrigin and mirtazapin but I still experience daytime depression. The depression disapears in the evening. Will this help with daytime depression?
It really depends on the overall understanding of the condition. So difficult to say without an understanding of the symptomatology. In general it is meant to improve motivation through the day . Also day time depression - is it low mood , motivation , or other Sx ? Ps not medical advice
Dr Sanil I am a medical student from India. Your videos are inspiring. I initially took Venlafaxine and Mirtazapine which made me emotionally numb and my psychiatrist added modafinil which increased my heart rate and BP. Hence I quit all three of them slowly. I then started vortioxetine 10mg upped to 20mg and Mirtazapine 15mg. Symptoms of depression have improved but there still is lack of focus and anxiety. Should I add agomelatine 25mg?
Thank you for your feedback. As you know im unable to give medical advice as that would be irresponsible. In general 1. Have mixed features been ruled out? 2. Is there any evidence of adhd as cognition can be linked to this? 3. Agomelatine can be safely combined with vortioxetine - agomelatine promotes dopamine release into frontal lobe which can help with cogntion and also is an anti anxiety agent. Mirtazapine at lower doses mainly acts as antihistaminergic agent with some with anti- anxiety properties so is unlikely to address cognition ( see mirtazapine video). Please discuss this with your doctor. Wish you well.
@@PsychiatrySimplified Delighted to recieve a reply from you sir. Is it safe to combine Mirtazapine 15mg Vortioxetine 20mg and Agomelatine 25mg.Mostly I have had recurrent episodes of depression and anxiety and it has affected cognition too but taking psychostimulants is difficult due to physiological side effects.I saw your video and am curious if I can add agomelatine to Vortioxetine + Mirtazapine
@@sandyyy66661 I can't specifically advise in your case. Pharmacologically yes the three can be combined safely as minimal risk of serotonin syndrome. If activation is present with stimulants or activating ADs but benefits are obtained then considering agents such as clonidine to counteract this anxiety also is a strategy. See video on clonidine. Also covered on psychscenehub.com
I'm an MD who had trouble sleeping since my early teens. I got a little too addicted to zopiclone (15 years of chronic use) I took a similar combo Duloxetine+Mirtazepine recomeended by a psych friend to get off zopiclone. That triggered panic attacks. I quit after 4 days.
The reason of your depression is 100% overwork/lifestyle/chronic stress. For our particular population (high functioning/intelligent - you got into medical school) Most psych drugs will do more harm then good.
I got recommended Vortioxetine next but I took a look at the 3 day half life of the drug and decided against flooding my brain with serotonin again, cause the first time was a nightmare. I tried pregabalin too but that kills my Libido.
Next up will be the good old diazepam taper I think. I regret ever taking any psych meds. But I did sleep well for over 10 years on Zopiclone. It just crapped out eventually.
when you have your psych rotation in the hospital have a look at actually depressed patients..... those ones benefit most from SSRI's. The closer to normal you are the less the benefits to you and the greater the chance that even minimal side-effects will negatively affect your overall well being.
I have been on agomelatine for the past 9 months and it has helped a lot, but the cost of each prescription ($60 a month) is making me consider switching to fluoxetine instead, as it’s not covered by the PBS in australia. What would you recommend? Is it a bad idea to change just because of the cost?
It would be inappropriate to answer that without knowing individual factors. Your doctor will be in the best position to do that. Each individuals ascribes a different value on the symptoms relief when weighing up the cost.
Hello doctor.. is there any evidence of hair loss taking agomelatine? How often should I get my liver function tested?
Hi, doctor!! I suffer anxiety but serotonine pills makes me diarhea and the only one I have tested since 6 months was duloxetine but it is not effective for me. Do you think agomelatine could be effective for my anxiety?? Thank you
Can t give advice but it is a good agent that has minimal GI effects as it doesn’t affect the 5HT3 receptor in the gut like SSRis and SNRIs
Can I please ask why is it I have started talking agomelatine that is doing anything but regulate my circadian rhythm, it makes me drowsy then I’m up at 1am and can’t go back to sleep . I’ve read so many people on reddit say the same thing. Lack of sleep and insomnia is absolutely horrendous for my anger and mental health. Why do they keep saying it promotes sleep when it doesn’t
A medication and it’s effects are related to its pharmacology plus the patient factors - so if one experiences insomnia with Agomelatine this can indicate a mixed state being present where any AD worsens the state . This is one example only. In general symptoms such as insomnia , nightmares or vivid dreams , racing thoughts should be ruled out. See video on insomnia and mixed features.
Thanks for this informative video! Are there any known effects on blood pressure?
No effects on BP
Thank you for this video. I've only been able to find limited information on Agomelatine.
Is Agomelatine associated with worsening of depressive/anxiety symptoms when first starting it? I am one week into Agomelatine and have found my symptoms have increased.
I am not sure if this is from starting the Agomelatine, or if I am still having symptoms from tapering off Sertraline? A bit of both perhaps? Hoping it subsides in the next few days.
I've had no physical side effects from starting Agomelatine though.
Thanks again!
It can activate for some individuals - but should wane - if it persists then mixed aspects ( racing thoughts etc ) to be Rx. But yes it can be due to sertraline reduction as as SSRIs are reduced the DA release in nucleus accumbens ( limbic system) increases which can compound the activation.
@@PsychiatrySimplified Thanks so much for your reply! I have a follow up with my Psych in around 3 weeks. I suspect it may be a rebound effect combined with the addition of Agomelatine. There has been quite a few changes to my treatments.
@@farrie82 wish you well 👍🏼
So I’ve been on it for a bit over 2 weeks now. Huge increase of agitation, anxiety, socially withdrawn. Could this be a tigger for something more than anxiety/depression? Contacting my psych tomorrow (Monday) Just thought it was interesting that it’s significantly increased these symptoms.
@@farrie82 worse or wired with antidepressants ( W as part of whiplashed mnemonic) is part of MDD with mixed features. We have done a video on that. How to Diagnose and Treat Major Depressive Disorder with Mixed Features - A Rapid Summary
ruclips.net/video/hVMObsNmnf4/видео.html
For severe depression would you recommend Agomelatine or Parnate? I keep hearing wonderful things about Parnate but have just got a two week script for Agomelatine from my Dr. She was also talking about Parnate but I keep hearing bad things about Agomelatine and the Liver now>?
Here is a video on antidepressants : ruclips.net/video/VJ6R49VueU0/видео.html Agomelatine is generally safe as long as LFTs are monitored as per recommendations. It’s not a common side effect though. MAOI s also can be associated with liver dysfunction. Article here - psychscenehub.com/psychinsights/maoi-psychopharmacology/
Ps not medical advice.
@@PsychiatrySimplified Thank You for your reply and for your videos. Very helpful indeed!
I have a question does olanzapine treat emotional blunting from ssri because it has 5ht2a antagonist property?
It's not technically used for that purpose as it also has a dopamine D2 antagonistic property at the same time.
It is effective in dosage at least 125 mg daily. Firstly it helps on 50 mg but then up.
125 mg? That is a high dose? Is that the dose you found it effective?
Firstly dosage of 50 mg helps very well. Then I found offlabel experiments in net with 75 and 100 mg. And I tried 100 mg for 4 weeks with no help as previously 50 mg helped. So I think because of tolerance effective dosage is at least 125 mg. I am persuaded in this Then I was hospitalized. And now I have money only for 75 mgs with desire to up to 125 mgs in future. Thanks for attention.
@@PsychiatrySimplified
I want to take this for entire of my life. I can start to sleep in 30min in the dark without any delay so its useful. I'm 28-year-old now, and I will increase dose to 2 tablets at the age of 55. Can it be harmful to liver or can it accelerate pineal gland's aging?
Liver tests are monitored initially at baseline, 3,6,12,24 weeks. There is no evidence of long term liver dysfunction. Also if LFTs rise initial stages the doctor will advise what should be done. Also the medication only activated melatonin receptors so does not affect pineal gland melatonin release . Ps not advice
Hi Sanil, I am considering either agomelatine or escitalopram for anxiety and ocd. I was wondering which you feel would be more effective. I was thinking that escitalopram would be the safer bet but I am worried about tolerability and sexual dysfunction. If one say tries escitalopram could, if there are sexual dysfunction issues, one add agomelatine as an adjunctive to reverse the problem?
First question - both a re efficacious in anxiety . Escitalopram > at higher doses for OCD - but agomelatine hasn't been around that long - in clinical practice it can be helpful for OCD. Second question - yes. PS not medical advice - your doctor will provide answers for you specifically.
Thank you so much for your kind reply. The other drug I am considering is buspar. In your opinion how would this compare with agomelatine and Escitalopram for GAD and OCD
Hi Sanil, further to the above Im wondering about the effects of long term use of agomelatine on sleep. For example will the melatonin receptors become desensitised over time, and then say after coming off the medication, normal sleep could be permanently impaired ?
@@lcy_123 is sleep an issue now? Medications effects are best considered in the content of what they do to a pre-existing state.
@@lcy_123 it’s difficult to answer this as 1. So many factors play a part in making a decision to choose a medication 2. Medications are chosen not for the Dx label per se but for the specific Sx in the context of individual factors . E.g of sexual dysfunction is a concern Agomelatine or buspirone may be preferred. If OCD Sx is an issue > GAD - then Escitalopram potentially > Agomelatine ( this depends) . If sleep is an issue Agomelatine may be preferred - ultimately it’s individual factors + medication properties + symptom targets + patient preferences + evidence = choice
I've been on this drug for a month,it improved my mood in an almost miraculous manner but the extreme insomnia is sadly negating the incredible mood lift and seems to show no sign of abating. This is perplexing any ideas how long to tolerate the insomnia before giving up?
Discuss this with your doctor as that can be counteracted by understanding the nature of insomnia. How to Evaluate and Treat SLEEP PROBLEMS and INSOMNIA? - A Quick Guide | Psychiatrist Explains
ruclips.net/video/Rrdx11rDa9o/видео.html
Oh so it keeps you awake I need soemthing for insomnia 🤧😴
@@kufudokungfu no it doesn’t in all - majority it does help with sleep - but if insomnia occurs other causes should be evaluated
Dear Doctor, can you tell if Agomelatine effects the gastrointestinal tract differently than SSRI and SNRI? I desperately need an antidepressant but cannot tolerate them due to severe reflux desease - meaning stomach gas burning my throat/larynx. I tried Duloxetine, Sertraline, Excitalopram and Citalopram but they all worsened my Larynx reflux so bad that I had to stop taking them. Could you tell if Agomelatine or another antidepressant doesn't cause reflux? I'm really desperate...Thank you❤
Agomelatine is not associated with GI disturbances generally. Liver function tests should be monitored but overall has good tolerability profile overall including GI side effects
@@PsychiatrySimplified Thank you so much for your reply ❤
Hi there, I’m keen to try this medication for GAD as I am very sensitive to SSRIs however it is not available where I live (New Zealand). I’m wondering if you would be able to do an online consultation and prescribe from Australia. Much appreciated,
Yes unfortunately it's not available in NZ. Due to medicolegal reasons its not possible for the latter. Wish you well.
Thank you so much for your kind reply.
hello Doctor, thank you great channel. I have a question if you would consider adding vortioxertin to Duloxetine (30-60 mg) when diagnosing GAG and having cognitive and sleep problems? do you have any practical experience in this matter? Best regards Peter.
Hi Peter. Vortioxetine has SSRI like properties and adding it to duloxetine could result in risk of serotonin syndrome hence not recommended. There are other augmentation strategies e.g agomelatine which is now approved in Aus for GAD. Hope this helps
I started a week ago half tablet that is 12.5mg I feel improvement in my depression and anxiety. Plz advise should on continue on the same dose or need to be increased
We cannot give medical advice. Please discuss this with the prescriber. Doses of agomelatine vary between 25-50 mg in general.liver tests should be monitored
How are you feeling now? Did it help your sleep at 12.5mg per night?
Hi i suffer from dry eyes and tried every antidepressent for my anxiety and depression , they all worsened my dry eyes . My doc is precribing this for me after liver test , do you know if it has drying effects please as i desperate to find one that helps me . Great video . Thankyou
Which ones did ? Agomelatine is unlikely to but have other causes been ruled out ?
Thankyou for replying . I've tried most antidepressents and like I said they worsened my dry eyes and I don't take any other medication . My GP contacted an advanced pharmacist and he prescribed vortioxitine low dose which made my eyes worse now I'm about to try Agomelatine I'm praying it helps 🙏
Good luck
If i have to take it at night, then why my doctor prescribed it at afternoon? And lexapro morning and evening?
You will have to discuss this with your doctor to explain the rationale
Is it normal to get increased feelings of anxiety and stress when first starting it? I started it 2 days ago and instantly felt more anxious and stressed
In some yes but if it doesn't settle in a week or continues increasing this should be discussed with the doctor. Usually this can happen if there is hyperarousal ( vivid dreams or restless sleep etc) or mixed features ( see our video on mixed features) - racing thoughts, irritability, mood swings etc. Discuss this with your doctor
I am taking AgoMelatonin for like 4 years at the evening 50mg. But My question is. I feel better I would say and more calm after I took it. Is it possible to take AgOMelatonin via the daytime? I read one study about the flight attendant and she needs to take it through a crazy time schedule. So she took the same amount at 11pm. Because of the job day, she takes it in the daytime - different times and so on Based on the study she was doing fine. She wasnt sedated or something and she was capable of doing her job via daytime after the dosage with no problem and she was fine. Is it maybe for someone better to take it via daytime? And Sorry for my english
Generally it’s meant to be taken at night time due to the melatonin agonist action. But shift workers take it at different times ( essentially one hr before bed is recomended) . There is no contraindication in taking it dieting the day if sedation is not an issue and the individual maintains the benefits
Thank you ♥ @@PsychiatrySimplified
Hi Doctor, can a person take agomelatine and st johns wort together?
Can’t provide advice here as depends on many factors. Pharmacist and doctor will advise appropriately.
Would you recommend this over Lexapro or escitalopram for GAD?
In terms of efficacy both are efficacious - agomelatine has a better tolerability profile with regards to low or negligible risk of emotional blunting and sexual dysfunction: agomelatine is also not associated with withdrawal Sx to same extent as lexapro. Ps not medical advice.
@@PsychiatrySimplified thanks. Lexapro hasn't been cutting it for me
Is it possible to taper off this medication, (The doctor put me on it for social anxiety which it doesn’t do anything for ) , I’ve tried but it’s hard as it only comes in two strengths and not in liquid form so you can taper off , when I try to taper I get very bad side effects of anxiety and feelings of doom and panic . I’ve tried other ssris but I get bad heart palpitations so I don’t like them and again they did nothing for social anxiety.
sorry to hear. Is the doom and anxiety different from the anxiety you normally experience? Agomelatine is one of the medications that has a lower propensity for withdrawal so curious about this.
@@PsychiatrySimplified no I actually was put on ssris for social anxiety but they never worked so the doctor put me on valdoxan but still no good for social anxiety it only helps with your mood
Same i get bad heart palpitations too from almost everything even coffee, alcohol, valium even just small amounts of stress
Hi again, I hope you're well. I have another couple of queries regarding agomelatine. 1) would one be able to safely take agomelatine indefinitely (with liver checks) similar to say other SSRIs or is it design for short / medium usage 2) If one experiences side effects on taking (such as increased anxiety), how long would one persist on the medication, hoping for it to take effect before giving up (I suppose this queston could be asked for any anti/depressant.) 3) If one is experiencing anxiety side effects during startup can benzo's be used in the transition period. 4) How strong is the adrenaline effect on patients, and could this increase anxiety 5)While the drug is listed as having no withdrawal issues, if one was experiencing it, how could one taper (the tablets don't have a dividing line and have a coating).
Thanks so much for any advice you could kindly offer. 🙏
1. Yes 2. Depends - yes for any AD - discussion with Doc - risk & benefit analysis 3. Yes 4. Not significant 5. No significant withdrawal. If insomnia is Rx or anxiety is treated - these Sx could relapse.
Thank you so much for your kind reply 🙏❤️
Could agomelatine be taken with duromine? (Depressed and fat) I can’t find any contradictions but 1 doctor said no, another said yes. Confused?
Theoretically It can be taken under supervision. The main side effect can be activation or agitation. There is a risk of switch if bipolarity or vulnerability is present. Similarly with a vulnerability to psychosis. Thus monitoring is important. Thus an individualised risk benefit analysis is needed. Ps not medical advixe
I m suffering from GAD and insomnia due to anxiety
So can i start with agomelatine 25??
We can't provide individual advice however, agomelatine is evidence-based in GAD. It can also help sleep. However it is important to ensure that the insomnia is not due to activation or agitation so after starting agomelatine if insomnia worsens one should discuss this with the doctor.
Can this medication increase anxiety and full body tingling? I had an increase to 50mg and a month later had big increase in restlessness which I also felt on vortioxetine and buproprion, but I had also discontinued 100mg Seroquel for insomnia around that time. My anxiety disorder is much worse even though the depression has lessened a bit. Reading akathisia sounds so similar to what I feel right now. 4-6 weeks since stopping Seroquel.
Activation with antidepressants can indicate a mixed state. Please see the video on major depressive disorder and mixed features. Stopping quetiapine can also result in rebound Sx - which can include agitation, restlessness...
@@PsychiatrySimplified thanks. I'll ask my psychiatrist.
@@PsychiatrySimplified can stopping Quetiapine cause akathisia? I've had long term depression but never any manic or hypomania symptoms that I've seen listed. I do have ADHD, gad, PTSD, autism so it's a mixed bag. Diagnosed with treatment resistant depression as well. Moclobemide lowered my anxiety. I'm waiting for tms to be available locally. Agomelatine 25mg didn't increase the anxiety though, I changed to that after moclobemide. I'm not sure if they can work together. I have a very beneficial effect from dexamphetamine and been stable for 12 years on that and the meds never caused any anxiety for me. Only benzos and moclobemide have reduced anxiety. I didn't have this feeling before starting the Quetiapine and it even breaks through the oxazepam and clonidine.
Stopping quetiapine can lead to symptoms similar to akathisia - most likely due to antihistaminergic rebound. It depends on the dose, however. Quetiapine reduces activation - so if that os removed and the medication prescribed is activating them, it can appear as if it is the removal of quetiapine that is doing it - but the other side of dose adjustment of existing medications also needs to be looked at. The combination of moclobemide, dexamphetamine and agomelatine is activating - Moclobemide is RIMA - so a combination with dexamphetamine should be discussed. Your doctor is the best person to speak to about this. As they will know the rationale.
@@PsychiatrySimplified how long is the Seroquel rebound? Does taking a small dose fix or another type fix? And are there any without weight gain issues.
Hi HRU thank u for your helpful information and advice I have major depression and anxiety ocd as well I am 32 I got this problem when I was 15 I live in Australia have good job kids wife everything I have and I taking zoloft for 5 years I changed many of anti depression tablets none of them helped me finally I started agomelatine 3 days please please give me advice is this medication is okay for me or not thank u again ❤❤❤❤❤❤😅😅
anyone else got tingling with this? my top lip is tingling after i touch my lips or kiss or anything. its like my mouth is burning almost.... ive been on this for 2.5 weeks
Has this been discussed with your doctor? Have dermatological or allergic aspects ruled out? It's not a common side side effect but unusual ones can happen - at the same time other aspects should be ruled out. There is a syndrome called burning mouth syndrome that is described with antidepressants in case reports mainly. Ps not medical advice. Wish you well
@@PsychiatrySimplified hey no not yet! i’m not on any other meds, don’t use anything else on my mouth and don’t have any other health conditions so it had to be this sadly. hoping it reduces or something, im on the very cheap generic so not sure if i’m reacting to a filler ingredient either.
@@sugaplumalex yea certainly something to take into account.
Can be associated with SSRI OR SNRI? THANKS DOCTOR
Associated ?
But why it is not approved in the US ?
FDA makes their own decisions - many factors come in cost / reimbursement / availability of other medications / trial results etc
Will this help or cure PSSD post ssri sexual dysfunction?
It is difficult to say. Agomelatine is associated with minimal risk of SD and is used to treat SD. No specific trials in PSSD so that's not known.
Does it treat emotional blunting?
Because i feel emotional blunting after taking fluxotine 25 mg for 3 months.
i left this medicine since 4 months ago but the side effects is same
My doctor put on different class of ssri one by one till the last one virtioxitine but still my mental health become worsen after each of ssri.
Now my doctor prescribe me snri(effexor 75mg) but our doctor in my country doesn't believe the side effect of emotional blunting.
(1)I feel completely blunt to emotions, pleasure,sadness
(2) unexplainable Sensation or whatever you say to it remain all time in head to affect on my thinking concentration.
We are realising a video on emotional blunting and the changes ssri’s and snri’s create in emotions - positive and negative. Agomelatine and vortioxetine do not lead to emotional blunting and may treat it as well.
@@PsychiatrySimplified you videos are really helpful
I am fasting because of ramzan.
(Holy month in islam)
I will keep remember you in prayer.
Don't lose motivation.
Make video on emotional blunting by ssri or snri.we are waiting.
@@mieero Ramadan Mubarak. Thank you for your feedback.
Did you recovered from emotional blunting ? I am in the same situation like you were a year ago . Please rply me .
@@SM-by8mg no bro no but little improvment, may i will start some dopamanic medicine..
I was taking 40 mg citalopram and 75 mg bupropion i recovered from depression but my head feel heavy and dizzy everyday then doctor change bupropion to agomelatin 25 mg.
Is it safe to take agomelatin with citalopram and is it more effective than bupropion?
Plz answer
In general - safe to take.
More effective depends on what symptoms. Bupropion is more potent Noradrenaline and Dopamine potentiator
@@PsychiatrySimplified thank you so much for your reply
One more question please answer
I sleep 8 to 9 hours daily
will agomelatin make me more sleepy during day and night if my sleep is already ok
Not necessarily. Its not sedatiing as such - rather improves quality of sleep. But individual responses may vary.
Does taking valdoxan cause body pains.Dream too bad with this valdoxan
That could be activation from the valdoxan. Rule out mixed states.
Does agomelatine help with attention and concentration since it works on norepinephrine and dopamine? Thank you 🙏👍
Yes It can in milder situations where attention and concentration are affected.
Does it help in ADHD as my psychiatrist have prescribed me saying that since methylphenidate is increasing your BP we are gonna try this
It can increase BP but not in everyone. high BP can be managed with Ritalin. In an individual that is generally healthy - it does not lead to sustained hypertension - but if there are risk factors then BP should be monitored. It is part of prescribing methylphenidate. Ps not medical advice
@@PsychiatrySimplified please tell me that . Does antidepressants associated weight gain is reversible as I am trying hard to shed some pounds but I am unable to as i feel my metabolism got severely affected after depression treatment
@@PsychiatrySimplified in india only methylphenidate is available and if it doesn't work they give adderall or modafinil as off label prescription
Liked the video, however sideeffects are not even really mentioned here what I think is problematic. My experienced with it; I had no problems with sleep but now I do; cant sleep right away, wake up in the night etc. Yesterday was especially worrisome, my thought became very irrational - so that I decided to quit taking it.
Activating effects can occur in some. In such cases mixed features should be ruled out. Often this SE is due to underlying mixed state not ruled out. In mixed states most antidepressants lead to activation. How to Diagnose and Treat Major Depressive Disorder with Mixed Features - A Rapid Summary
ruclips.net/video/hVMObsNmnf4/видео.html
While this is one explanation other medical & sleep conditions should also be ruled out . Wish you well . Ps not advice
Sir.. Can agomelatine treat generalized anxiety disorder??
Yes it had been approved for this purpose.
Sir my doctor prescribed me this medicine at night time.. So i take it before sleeping at 12 am. But i have to go for pee because for intake water for this medicine.. So for avoid pee in which time may i take this medicine in night time? Can i take it at 10 pm at night time and go for sleep at 12 am? Is it okay sir?
@@princekhan9160 you will have to ask your Doctor. The medication does not have a diuretic effect .
does it help with motivation apart from antidepressant effects
Yes due to the DA and NA potentiation effects. However this depends on the severity of amotivation. It can help at the milder end of the spectrum.
@@PsychiatrySimplified can lamotrigine help with amotivation syndrome? if not what medication is best except stimulants
@@rationalist_18 Lamotrigine is unlikely. Antidepressants with Noradrenergic and dopaminergic potentiation help with motivation. E.g bupropion, Vortioxetine higher dose etc
So far intaken 2 i feel blunt and sad
It does have withdrawal symptoms I can tell you that for sure it’s impossible to come off !
Interesting. How long was it taken for? What were the withdrawal Sx?
@@PsychiatrySimplified hi I had to keep taking it as it’s very hard to taper off as it doesn’t come in liquid form , i tried to go to an ssri but I got bad heart palpitations do I went back on valdoxan the brand name , I decided to stay on it during covid as I was very isolated due to lockdowns but I’d like to try to go off it again and try to use diet and exercise to cope with my anxiety issues
OK so this drug helps with anxiety depression but create more insomnia?
It can help with insomnia because of m1 and m2 agonism. But in some individuals insomnia can get worse if it’s activating - it usually means one has to look closely at other causes of insomnia
@@PsychiatrySimplified OK I HAVE LIKE 1 WEEK'S WORTH OF TABLETS I HAVENT DIVED INTO THEM YET
@psychiatrysimpified Can agomelatine cause hair loss?
Not a common side effect. But there are unusual side effects that we see with medications - if one thinks its related - discuss this with your doctor.
Thanks so much for your reply. Do you mean unusual side effects for medications in general?
I am starting to get liver enzyme increases, my Doctor thinks I should continue I am too worried now.
In general recommendations are that the medication does not need to be ceased unless the LFTs show a 3 times increase from baseline. However an individual risk benefit analysis will be carried out by your doctor . Wish you well
@@PsychiatrySimplified One of mine AST: is 63 and ALT: is at 99 after 12 weeks?
@@wisdom121withmichaelgrima3 Depends on baseline and lab upper limits. Also, best to discuss this with your doctor, asking for their opinion.
Can I get a private consolation ? And why are all my side effects going away with carnivore diet?
What side have gone away on the carnivore diet using this antidepressant ?
Is that going to cause sleepiness ?
generally not sleepiness but improves slow wave sleep (deep sleep). so no day time sedation is expected. ps not advice
Is it toxic to the liver?
Liver function tests should be monitored. This is what a 2015 review stated - In this review, agomelatine was found to be associated with higher rates of liver injury than both placebo and the four active comparator antidepressants used in the clinical trials for agomelatine, with rates as high as 4.6% for agomelatine compared to 2.1% for placebo, 1.4% for escitalopram, 0.6% for paroxetine, 0.4% for fluoxetine, and 0% for sertraline.
Considering this drug increases dopamine and noradrenaline, and that’s the same thing ADD medication does (I’m on Vyvanse), Is there such a thing as too much of these neurotransmitters?( being on two drugs that do a similar thing in the brain?) My sleep is terrible from Vyvanse and adding this might fix that. Mirtzatapine left me being way too groggy the next day,extremely aggressive & super rapid onset weight gain/binge eating at 15mg. I stopped Mirtzatapine after 2weeks.
The medications differ in their ability in terms of dopamine release. So Vyvanse (we did a video on this) is much more potent in its DA and NA release than agomelatine. So for ADHD agomelatine is not a usual treatment. In clinical practice, there are times two medications may be combined to 'augment' the effect to target symptoms. Mirtazapine (we did a video on this) for example has antihistaminergic properties leading to weight gain, increased appetite and sedation. Mirtazapine at higher doses provides NA and DA. Ultimately augmentation is a valid strategy if the clinical symptoms are understood properly and the synergy between two medications is used to target those symptoms. For example, in depression, an SNRI and mirtazapine may be combined to provide a broad spectrum of neurotransmitters (serotonin, dopamine and NA) because SNRI on its own may not be able to do so. in ADHD sleep disturbances are often due to circadian rhythm dysfunction (agomelatine has a prominent antidepressant effect - so while it can help sleep ) it can also 'activate some individuals. . In ADHD usually alpha 2 agonists such as guanfacine or clonidine (we have done a video on this) are used to counteract the sleep disturbances or melatonin in some milder instances. Please note this is general only and is not advice as each individual is different. This playlist on ADHD may provide a better understanding - ruclips.net/p/PLV0KZkVDyoOEOaE9DoJgpXzCXi_0b4sZz
Is it dangerous? I took it for 9 months
No, it is not dangerous when prescribed appropriately under medical supervision.
What’s your view on the meds? Was it helpful? And why did you choose it?
Excellent content - Thank you. I am just over 1 week into agomelatine and it is an absolute game changer for me. I have PTSD and score quite high on the ADHD spectrum. My symptoms are depression, high anxiety and issues with sleep (night terrors) and ability to focus.
I have tried SSRIs and SNRIs and after a week on these I was curled up on the couch with tremendous anxiety and at one stage a pin prick rash all up my torso.
1 week on a half dose of agomelainte 25mg, I am sleeping like never before, my nerves are so calm and my focus is improved. I have a pleasurable amount of emotional blunting which is bringing me peace and an improved sex drive.
Previously I have self managed my symptoms with diet and exercise and while these methods are still important I am absolutely sold on agomeltine.
I think my doctor’s intention is to move me to the full 25mg dose shortly (and will confirm this with my doctor) but I am not sure whether I should encourage a change in dose given the positive results so far.
What do you think… is it reasonable to support any recommendation from my GP to increase dosage if symptoms are already positive at exisiting dosage? What is a standard approach for another patient in this position?
Oh my . . . finally! a video on drugs that doesn't have the audio quality of a deceased whale Q-Q
Worst part about finding this now is it sums up a lot of information that took me hours to find thanks for the video :)
Respected sir, please let me know how effective is AGOMELATINE for patients with OCD, ANXIETY and some depression
Age: 61F with type-2 diabeties(borderline), coronary heart disease
Psychiatrist treatment history:
1. Fluoxetine 20mg (x3 weeks)
Switched to
2. Paroexetine 25mg CR (about x3 weeks to be completed shortly) with clonozepam 0.25mg (for sleep)
She started having issues having interest in anything, seems SSRI induced apathy
Q1. How to treat this apathy / emotionally detached feelings which started after SSRIs
Q2. Can AGOMELATINE alone help her, if so, how can we switch to it and what dosage to start.
brick wall 6.29 666
Can you take melatonin at night as well as taking agomelatine?
There are no contraindications as such but for individualised treatment best to ask your doctor
Thanks Dr, appreciate your reply.