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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Beckett on April 27, 2014, at 16:59:48
Is this available in the States?
Anyone with physical symptoms associated with depression have any relief? I am leary of online sources never having purchased psych meds that way.
Posted by klein on April 27, 2014, at 17:58:26
In reply to Agomelatine in USA, posted by Beckett on April 27, 2014, at 16:59:48
> Is this available in the States?
>
> Anyone with physical symptoms associated with depression have any relief? I am leary of online sources never having purchased psych meds that way.Last I heard, Novartis withdrew agomelatine's FDA approval application a couple of years ago. It's available in Canada though.
I took it for 3 months in 2010... didn't do much of anything for me. It was disappointing, I had high hopes for it as it sounded very good on paper.
What's especially annoying about Valdoxan is it's incredibly vague instructions ("take before retiring"). Uhmm... that's not specific enough for a drug that supposedly regulates your circadian rhythms. Maybe the prescribing info has been updated since then.
What kind of physical symptoms are you experiencing? For pain, low energy, disrupted sleep etc Savella (milnacipran) could be an excellent choice. Apparently Cymbalta works well too, but I don't have first hand experience with that one.
Posted by Phillipa on April 27, 2014, at 18:09:11
In reply to Re: Agomelatine in USA » Beckett, posted by klein on April 27, 2014, at 17:58:26
Somehow I thought it was available here. Didn't know it was with held. Phillipa
Posted by Louisiana Sportsman on April 27, 2014, at 20:37:25
In reply to Re: Agomelatine in USA » Beckett, posted by klein on April 27, 2014, at 17:58:26
> For pain, low energy, disrupted sleep etc Savella (milnacipran) could be an excellent choice. Apparently Cymbalta works well too, but I don't have first hand experience with that one.
>The USA also has Fetzima which is Forest's recently approved levomilnacipran extended-release capsules that are indicated for MDD but not fibromyalgia.
Posted by Beckett on April 27, 2014, at 21:41:41
In reply to Re: Agomelatine in USA, posted by Louisiana Sportsman on April 27, 2014, at 20:37:25
Fetzima? Is that to savella what pristiq is to effexor?
Posted by Beckett on April 27, 2014, at 21:59:14
In reply to Re: Agomelatine in USA » Beckett, posted by klein on April 27, 2014, at 17:58:26
Hi Klein,
That does sound disappointing. What symptoms are you treating? I have lethargy, slowed thinking, diminished interest. I need some pain medication, and after trial and error found tramadol er. I am reluctant to try a maoi because most pain medication (non-narcotic) is contraindicated, otherwise I would. I need to be mindful of mood destabilization, although I might welcome it now.
Posted by Hugh on April 28, 2014, at 9:52:11
In reply to Agomelatine in USA, posted by Beckett on April 27, 2014, at 16:59:48
I took it several years ago. It helped me get to sleep, but that's about it. I used to belong to an agomelatine google group. Agomelatine helped some people, didn't do much for most, and made some people feel worse. About like any other AD. Mine was manufactured in France.
Posted by klein on April 28, 2014, at 10:11:52
In reply to Re: Agomelatine in USA, posted by Louisiana Sportsman on April 27, 2014, at 20:37:25
> The USA also has Fetzima which is Forest's recently approved levomilnacipran extended-release capsules that are indicated for MDD but not fibromyalgia.
>I forgot all about Fetzima, Louisiana. Its approval for MDD is very significant I think. Milnacipran is a good anti-depressant. Fetzima's side effect profile looks a bit better than Savella's, though, at least on paper. Have you tried either one? I stopped Savella because it was making me extremely drowsy, the exact opposite of what I had been hoping for. The hiperhidrosis was ridiculously bad too, but my pdoc came up with a solution that worked very well (Ditropan).
Hmm.. I notice that levomilnacipran was identified by Fabre back in 2000. I have to wonder if this isn't a new marketing technique, like a "reverse evergreening" of sorts. Maybe Forest didn't push Savella's approval for MDD hard enough, opting for an exclusive fibro indication instead because they knew levomilnacipran was in the pipeline.. so now they have two "different" products (one for fibro, the other for MDD) under patent protection til 2020+.
Posted by klein on April 28, 2014, at 10:31:38
In reply to Re: Agomelatine in USA » klein, posted by Beckett on April 27, 2014, at 21:59:14
> Hi Klein,
>
> That does sound disappointing. What symptoms are you treating? I have lethargy, slowed thinking, diminished interest. I need some pain medication, and after trial and error found tramadol er. I am reluctant to try a maoi because most pain medication (non-narcotic) is contraindicated, otherwise I would. I need to be mindful of mood destabilization, although I might welcome it now.Beckett,
Savella and, like Louisiana mentioned, Fetzima could be worth a shot for those symptoms, including pain management. Elavil could also be worth a shot.
And yeah, definitely be very careful with combining Tramadol with serotoninergic agents. Serotonin syndrome might be slightly over-hyped, but not when it comes to MAOIs or Tramadol.
My MDD symptoms change a lot. The worst symptoms were these bouts of apathy and complete anhedonia that left me bedridden for up to a week at a time; I simply couldn''t get out of bed, yet I didn't feel sad, numb or in despair, just completely indifferent to the world. I eventually found a simple solution that works for me (benzos).
I'm currently struggling with lack of motivation and iffy sleeping patterns. Things are looking up though, I'm getting a lot of relief from Zoloft 300mg and Pristiq. Valrelease 15mg. I also alternate between Saphris 10mg and Geodon 40mg, mostly for sleep, but they help a whole lot with my negative symptoms and they boost my motivation (especially Saphris).
Saphris and Geodon have also helped my cognitive symptoms (once upon a time I used to be pretty sharp, lol) so I can see things a bit more clearly now. That's why I'll be doing some CBT, like I mentioned in your other thread, I feel unscrambled enough to go for it.
Warm regards.
Posted by Beckett on April 28, 2014, at 14:50:20
In reply to Agomelatine in USA, posted by Beckett on April 27, 2014, at 16:59:48
Thank you for the input. This was very helpful, and I appreciate it! I think a discussion with my psych is warranted. Fetzima might be a starting place. I am so sick of this depression which has lasted years (it just goes on and on) with a too brief remission triggered by dexedrine, which was prescribed for depression and triggered hypomania. However, it broke a year long period of anhedonia, which was a miracle. Too bad I build tolerance so quickly.
On another thread, there was the suggestion of Nardil. My fear is that it would help, then poop-out. And where would I be? It's a grim thought.
Posted by Phillipa on April 28, 2014, at 20:28:38
In reply to Re: Agomelatine in USA, posted by Hugh on April 28, 2014, at 9:52:11
Hugh have you heard from Marty? I helped him at the time. Lost track of him. Hoping he is well. Phillipa
Posted by klein on April 29, 2014, at 9:41:01
In reply to Re: Agomelatine in USA, posted by Beckett on April 28, 2014, at 14:50:20
> Thank you for the input. This was very helpful, and I appreciate it! I think a discussion with my psych is warranted. Fetzima might be a starting place. I am so sick of this depression which has lasted years (it just goes on and on) with a too brief remission triggered by dexedrine, which was prescribed for depression and triggered hypomania. However, it broke a year long period of anhedonia, which was a miracle. Too bad I build tolerance so quickly.
>
> On another thread, there was the suggestion of Nardil. My fear is that it would help, then poop-out. And where would I be? It's a grim thought.Beckett, I think that the key is acceptance. I hated feeling powerless over my depression and I used to struggle a lot with negative thoughts, until I realized that worrying worsened my condition. These days, I try to take it slowly, one day at a time.
Fetsima might work. Nardil might work. If it poops out, there are many other options out there. A med that didn't work for you , say, 3 years ago doesn't mean it couldn't work now because our brain chemistry is dynamic and changes over time (and the reverse is true, something that was a miracle a while ago might do squat if you try it again).
Have you considered seeing two doctors? Maybe you need one who specializes in pain management, along with a pdoc for your depression / OCD / anxiety.
And, sorry to badger you about therapy, but I get a feeling that you somehow feel guilty about your current condition. I think you could really profit from the right kind of counseling.
If money is an issue, there are other alternatives too.
What I'm trying to say is, just try to breathe and calm down and do the next right thing. Focus, don't get overwhelmed. I know it's hard but you can do it :)
Warm regards,
K- PS: there's this book that might help you, it's a short read "The Four Levels of Healing" by Shakti Gawain. It's quite new agey, but it has very useful ideas to help get you organized. Remember that you can overcome depression. Chin up ;)
Posted by Hugh on April 29, 2014, at 10:17:52
In reply to Re: Agomelatine in USA » Hugh, posted by Phillipa on April 28, 2014, at 20:28:38
> Hugh have you heard from Marty? I helped him at the time. Lost track of him. Hoping he is well. Phillipa
The last time I looked at the agomelatine group, he hadn't posted in quite a while.
Posted by Phillipa on April 29, 2014, at 20:33:56
In reply to Re: Agomelatine in USA » Phillipa, posted by Hugh on April 29, 2014, at 10:17:52
Thanks.
Posted by Beckett on May 3, 2014, at 0:44:05
In reply to Re: Agomelatine in USA » Beckett, posted by klein on April 29, 2014, at 9:41:01
Hi Klein,
I appreciate your input. You are right that I feel guilty about my illness (you said current condition). I am a parent, and for a variety of reasons, this drives the guilt. Beforehand, I had little guilt with the exception of not earning enough as my spouse and hindering our social life--but then my spouse would go out alone without much effect. I think CBT would be very helpful, and I discussed this with my therapist who felt this would be extraordinarily helpful.
I wanted to ask you a few questions, and if you've written the answers here, forgive me for asking another time. I have been wondering what conditions you are treating. I've gathered depression and, maybe, anxiety. If yes for anxiety, what works for you?
And since you seem knowledgable about current practice, do you know anything about suboxone? (I am not sure if that is the right name.) A year ago my physician suggested I try it. Recently the hospital wanted me to change from UltramER, and I didn't. I don't need tolerance, nor do I want to vomit if I run out of medication. But maybe I don't understand. My apologies if you have no idea. But I would love to hear more about you.
Posted by Beckett on May 3, 2014, at 3:12:16
In reply to Re: Agomelatine in USA » klein, posted by Beckett on May 3, 2014, at 0:44:05
Hey, forgive my major memory lapse. You've told me about yourself. I'm sorry about that. Could we say that my lamictal usage played a part? I have word retrieval malfunction. Which might be different from forgetting events. That's my post benzodiazapine thinking....
Posted by Dr. Bob on May 3, 2014, at 9:25:49
In reply to Re: Agomelatine in USA » Beckett, posted by klein on April 29, 2014, at 9:41:01
> PS: there's this book that might help you, it's a short read "The Four Levels of Healing" by Shakti Gawain.
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, a movie, or music without using this option, I post this to try to make sure he or she is at least aware of it.
Bob
Posted by Hugh on May 3, 2014, at 17:10:35
In reply to Agomelatine in USA, posted by Beckett on April 27, 2014, at 16:59:48
There's one thing I'll say for agomelatine -- its side effects were far milder than any other AD I've tried, and when I decided to quit, I did so cold turkey, with no withdrawal symptoms.
Posted by Beckett on May 4, 2014, at 0:04:17
In reply to Re: Agomelatine in USA » Beckett, posted by Hugh on May 3, 2014, at 17:10:35
I intend asking my psychiatrist. My sleep cycle is a shambles. It's usually past midday when I feel o.k. and despite efforts over the years I feel very awake at night. Maybe it will not destabilize mood.
Posted by Hugh on May 4, 2014, at 11:38:48
In reply to Re: Agomelatine in USA » Hugh, posted by Beckett on May 4, 2014, at 0:04:17
> I intend asking my psychiatrist. My sleep cycle is a shambles. It's usually past midday when I feel o.k. and despite efforts over the years I feel very awake at night. Maybe it will not destabilize mood.
Something that's helped my sleep far more than agomelatine or melatonin or benzos or blue light therapy is putting a heating pad on my back for 20-30 minutes shortly before I go to bed. The $20 heating pad I got at Walmart helps, but my $120 infrared heating pad works even better.
http://www.amazon.com/Thermotex-Infrared-Heating-Pad-Gold/dp/B002L13DF0
Some possible explanations -- though using a heating pad before bed works far better for me than a warm bath ever did:
http://drcatherinedarley.wordpress.com/2012/05/24/does-a-hot-bath-help-sleep/
http://www.wired.com/2008/02/heated-sleeping/
Also, check out this thread from the alternative board:
http://www.dr-bob.org/babble/alter/20131226/msgs/1060934.html
Posted by klein on May 4, 2014, at 15:16:46
In reply to Re: double double quotes » klein, posted by Dr. Bob on May 3, 2014, at 9:25:49
> > PS: there's this book that might help you, it's a short read "The Four Levels of Healing" by Shakti Gawain.
>
> I'd just like to plug the double double quotes feature at this site:
>
> http://www.dr-bob.org/babble/faq.html#amazon
>
> The first time anyone refers to a book, a movie, or music without using this option, I post this to try to make sure he or she is at least aware of it.
>
> Bob
>Hi Dr Bob!!
That's a cool feature, will definitely keep it in mind.
Trial:
"The Four Levels of Healing (Gawain)"
very cool!
Posted by klein on May 4, 2014, at 16:17:42
In reply to Re: Agomelatine in USA » klein, posted by Beckett on May 3, 2014, at 0:44:05
> Hi Klein,
>
> I appreciate your input. You are right that I feel guilty about my illness (you said current condition). I am a parent, and for a variety of reasons, this drives the guilt. Beforehand, I had little guilt with the exception of not earning enough as my spouse and hindering our social life--but then my spouse would go out alone without much effect. I think CBT would be very helpful, and I discussed this with my therapist who felt this would be extraordinarily helpful.
>
> I wanted to ask you a few questions, and if you've written the answers here, forgive me for asking another time. I have been wondering what conditions you are treating. I've gathered depression and, maybe, anxiety. If yes for anxiety, what works for you?
>
> And since you seem knowledgable about current practice, do you know anything about suboxone? (I am not sure if that is the right name.) A year ago my physician suggested I try it. Recently the hospital wanted me to change from UltramER, and I didn't. I don't need tolerance, nor do I want to vomit if I run out of medication. But maybe I don't understand. My apologies if you have no idea. But I would love to hear more about you.LOL no worries about your "lapse". I guess I should have introduced myself properly, kinda late now.
I won't launch into an autobiography, just the highlights or should I say "lowlights"
My diagnosis is unipolar major depressive disorder with melancholic and (maybe) schizoid features (I think these "schizoid features" are just SSRi-induced side effects). Throw in "treatment resistant" lol.
Before the MDD hit I used to struggle with panic and generalized anxiety. Benzos helped a bit (read on).
I'm also a recovered alcoholic.
The reason I'm so adamant about CBT is that it *cured* (I know that's a heavy word that is seldom used in psychiatry) both my panic and GAD along with my alcohol dependence. I've been sober for 7-8 years now, and I had my last panic attack about... 13 years ago now? I credit my two rounds of CBT for curing both conditions - I'm starting round number 3 sometime next week.
You're sharp ;) You noticed that I said "condition" and not "illness". That's the CBT working. I'm sorry if I sound new-agey but I firmly believe that we create our reality with our thoughts. Before anyone yells at me... Yeah, I think biochemistry plays a big role in how we feel. Ditto our life history.. and so on. But it's up to me... and it's up to you... to decide how to approach life.
For years I was told that alcohol addiction was a lifelong illness with no known cure. I was desperate. I relapsed and drank again no matter how hard I tried. Then I did some CBT.. read a few books. And I recovered for good. People on another board call me co-cky whenever I say that I'll never drink again. But it's the truth. My new reality doesn't include alcohol.
And, as for being called co-cky, well... no. I feel very humbled and grateful because a power much greater than me or you or alcohol helped me out, very gently. I could have never done it alone.
I prefer the word "condition". When I was ill, I had no cure. Why bother to live then? To prolong the suffering? For my family? My friends? I felt guilty and ashamed and useless... until I found "relief" by feeling empty. None of that had any meaning anymore.
Anyway. I'll stop here because you've probably figured out where all this is leading to ;) Along with your meds CBT or DBT or any practice or method that helps you rearrange your thoughts might help Beckett. I can't wait to start therapy again next week to see how it can help with my own current condition. Along with spiritual practice, which I'm starting again tomorrow. I know there's no need to join an actual group to practice meditation and so on, but I can't do it alone.. oops I mean "I prefer to ask for help and guidance".. I wish I could have done it before, but I felt too messed up to think straight. And that's where the meds came in and helped a whole lot.
Warmest regards.
Posted by Phillipa on May 4, 2014, at 20:03:58
In reply to Re: Agomelatine in USA » Beckett, posted by Hugh on May 4, 2014, at 11:38:48
Hugh I wonder if this why I now fall asleep reading my nook. As I have a heating pad on my back set at 147 degrees. It makes me tired. So I now sleep. Phillipa
Posted by Hugh on May 4, 2014, at 23:30:57
In reply to Re: Agomelatine in USA » Hugh, posted by Phillipa on May 4, 2014, at 20:03:58
> Hugh I wonder if this why I now fall asleep reading my nook. As I have a heating pad on my back set at 147 degrees. It makes me tired. So I now sleep. Phillipa
I think there's a good chance it's your heating pad that's doing the trick. When I would use my infrared heating pad during the day, I would feel groggy for hours afterward. So I decided to just use it close to bedtime, so it wouldn't mar my waking hours, and I started sleeping much better. Now I use it every night. Serendipity.
Posted by Phillipa on May 5, 2014, at 20:36:15
In reply to Re: Agomelatine in USA » Phillipa, posted by Hugh on May 4, 2014, at 23:30:57
Use mine for back pain and knew was falling asleep while reading but never made a connection to the heating pad. Has a dial to heat to desired temp and then length of time on. My Pt guy suggested I buy this one. It's great. I wonder if could just cut down on the benzos at bed then? If you are already sleepy why take them? Phillipa
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