Hi Dr. Sanil Rege - Great video! I have a follow up question if you have the time: 1. With a low half-life (1-3 hours) how can Agomelatine function as a potent anti-anhedonic/antidepressant/anxiolytic? With SSRIs we're looking at a SERT occupancy of roughly 80% (except vortioxetine maybe) and we'd expect to achieve steady-state. With Buspirone, having a similar half-life, one would have to take it a few times a day for it to be effective. I don't think I've ever heard of buspirone once-daily, but then again...who knows. Is MT1/2 agonism in SCN enough to lead to, say, 24-hr changes in neurotransmitter release and/or changes in certain circuits? The issue is even more puzzling when it comes to 5HT2C? Cheers!
The half-life is not directly related to the efficacy or side-effect profiles. In some cases they may in other cases they may not. The best way I can answer this is through an analogy. When we exercise we exercise for a few hours. Only it is the cascade off the biological changes and of course psychological social etc changes that result in the improvement of range of dimensions Subsequently. we might sleep for 6 to 7 hours, but it is the effect of the changes that occurred during that limited time that can have sustained benefits. It’s the same with medication. The medication does not primarily changed the rcognition, activity emotional dimensions. What they do is that they assist in making these changes through a cascade of interactions. Hope this helps answer the question.
@@PsychiatrySimplified Wow - Thank you so much for the fast reply! That makes sense. Last one if you're enjoying these questions: SSRIs would eventually downregulate 5H2C via excessive signaling and downregulation. Would you be concerned about "loss of insensitivity" if you combine an SSRI with Agomelatine, in this case Agomelatine "resensitizing" the 5HT2C receptor? Although I believe 5HT2C shows no upregulation with antagonism/agomelatine and inverse agonism may be needed for that Just some food for thought. And would def be interesting to see if any of these receptors-ligand interactions are also mediated by b-arrestins/biased signalling
@PsychiatrySimplified Why did some papers highlight that AM antagonizes 5HT2B? What’s your take on this? And how does 5HT2B contribute to the efficacy of AM?
The key about melatonin is not necessarily the 5HT2C or B on its own but rather the synergy of both M1-m2 agonist activity PLUS 5HT2C antagonism that is the Difference. “MT1 and MT2 receptors also form heterodimers with the serotonin (5-HT2C) receptor” . 5HT2B may be involved but its this heterodiner that is the postulated mechanism of agomelatine for depression
I take temazapam ad-hoc for sleep anxiety - maybe 25 tablets a year. If I don't sleep I get so anxious I can't sleep the next night so temazapam breaks that cycle. Occasionally my anxiety gets so acute I go on anti depressants. Twice in my life. My anxiety is always about getting to sleep. Would agomelatine be suitable for sleep anxiety? I've taken Zoloft twice in my life - it worked but puts on a lot of weight. Would ago melatine be good for sleep anxiety?
Agomelatine can help with sleep and is also evidence based on anxiety. Please also look at the video on insomnia we did to a get a broader understanding. Ps not medical advice
Follow up.... week 2 on agomelatine. Amazing! Im not over eating. Im not lazy like on zoloft, hitting the gym 3 times a week. No need for benzos. Cured my sleep and general anxiety. Worked in 3 days. Never touching an SSRI again. Only side effect is ive needed a few naps during the day. Liver tests next week. Fingers crossed! Ill be on this until im over a particularly stressful period of life. Going up and tapering of zoloft was hell. Going up on agomelatine was bliss. My GP said you can take your benzo but just see if you need it. Give it 2 hrs. I didn't need it. Sleep anxiety gone in 1 day. General anxiety started to blunt in 3 days. This stuff so far is utterly amazing for me.
Can you hypothesize as to why this is beneficial to ocd. I do lots of research on the subject and have used high dose Clomipramine, neuroleptics, fluvoxamine etc. currently using fluvoxamine with moderate benefit
It has some benefit for OCD but not to the extent clomipramine or fluvoxamine would . Agomelatine can help with OCD by improving the PFC control over the arousal and habit parts ( which medicate the compulsions) . It’s also possible that this group may have a mild adhd phenotype comorbid with OCD explaining the result .
This is really informative thank you. I have been recommended to switch from 25mg Sertraline to 25mg Agomelatine. I am sensitive to medications and have found coming off Sertraline harder than expected. What is the best approach to switching?
We can't provide specific advice however switching from sertraline to agomelatine can pose a risk of withdrawals- in such cases one can keep the low dose of sertraline for an extended period Nd attempt to come off when stability is reached if at all. Agomelatine combined with sertealine is an evidence based strategy so there are no issues with this combination and offers a synergy. The clinician can then decide the best steps forward based on the response. With this the withdrawal symptoms are minimised while at the same time depression is treated. Ps not medical advice
@@PsychiatrySimplified Thank you for your reply, I will bring this up with my doctor. Does Agomelatine have much evidence for anxiety as well? Sertraline even at low dose has helped my generalised anxiety, but unfortunately I have experienced slight apathy as well as weight gain, not disabling in terms of the apathy but enough to annoy me. Thanks again.
I will start with Agomelatin next week but I'm a little concerned about the possible liver damage (there have even been a few fatal cases in the past.. ). What does the current study say about this? So far I have found a lot of different information about it. I would also like to know whether it is possible to drink 2 - 3 glasses of wine per WEEK despite a possible increase in transaminase levels..? Of course, alcohol shouldn't have any priority, but when enjoyed among friends and in such small quantities, it is still a part of the quality of life for me.
It is uncommon but there are monitoring recommendations. There have been 6 cases worldwide. “Authors of this review state that liver injury associated with agomelatine is idiopathic and usually reversible. They suggest warning against factors that may increase risk for liver injury (concomitant alcohol consumption). Patients should be counseled that fatigue, nausea, vomiting and dark urine may indicate liver injury and should be reported immediately”.
I can only speak from my own experience, but I've been taking this drug for five years now, and my blood tests have always come back strong & healthy. Some people are vulnerable, but it doesn't appear to be common. As with any drug like this, it's important to remain consistent with check ups & blood tests, but assuming you do that, you'll have nothing to worry about.
Do you think agomelatine would help in long covid for POTS Vestibular migraine causing balance issues fatigue post excercise malaise and over active sympathetic nervous symptom?
Unlikely to target all of the above symptoms as it may need a multipronged approach. It can help milder levels of fatigue and insomnia ( but can worsen sleep in some individuals )
I was on valdoxan but I found it made me very groggy after wakening , I suffer from social anxiety and nothing works for it , I’m on Duloxetine now but again it doesn’t work I spend a lot of my time alone unfortunately
There a few ways around this. 1. Allowing time on Agomelatine as some can have the sedation with the effect waning. 2. If persists - halving the dose. 3. Social anxiety - CBT plus medication has best evidence.
Not really. Venlafaxine has 30:1 SERT to NAT so as doses go up even the SERT blockade goes up - which reduces ventral striatal DA. Bupropion has a NAT and DAT blockade and Modafinil has DAT predominantly with histaminergic and orexinogenic potentiation - some NA as well.
I have been on it for about 4 years Dt...but now my anxiety attacks have returned. Im on 25mg and had aweful effects being on SSRIs and this seemed to help with my panic attacks. My liver function is good....is adding another 25mg/0r half more of the tablet to the current 25mg effective? Im scared to go off it and not many dictors know too much about Valdoxan....please help. Btw...im now told i have Functional Dyspepsia proberly brought on by Anxiety. 😢
When anxiety breakthrough occurs the following aspects should be considered .this is not medical advice 1. Rule out medical conditions 2. Dose of Agomelatine - may have gradually led to activation - increase in anxiety . This occurs more in individuals with mixed states ( so individuals may have hyperarousal and agitation instead of just anxiety. This is important to rule out . 2. The Agomelatine dose may not be sufficient to address the anxiety 3. sSRis worsening panic attacks can point to underlying hyperarousal ( pre existing racing thoughts , insomnia , early morning awakening) - in such situations a buffer ( mood stabiliser or another agent to address the hyperarousal / agitation is needed) is needed to help the antidepressant work better. Please have a look at our video on Mixed features. One doesn’t need to go off Agomelatine if it’s helped - often it’s the mixed states that’s not addressed. It’s a common issue. Insomnia, racing thoughts restlessness that one can’t control are clues
Sir can modafinil reverse my anhedonia and low mental energy . The anhedonia and low mental energy caused due to 7 month using of escitalopram for depression. Is there any evidence that modafinil could reverse these issues. Thanks sir
There are multiple agents that have shown that emotional bunting can be treated. Modafinil, armodafinil, bupropion, vortioxetine, agomelatine. Essentially dopaminergic agents. However other symptoms should also be taken into account - for example if an individual is very anxious - a preoccupation Re emotional blunting may require a different approach. Hence it's important to carry out a comprehensive assessment
I’ve been taking it three weeks and I’ve had no sleeping benefits. ( I was on Vortioxetine for anxiety before . I added agomelatine and had to stop the Vortioxetine because on both I was getting severe nausea ) . I feel the same anxiety wise but would love some sleep. Still relying on benzos and sleeping pills right now. practicing sleep hygiene and doing CBT insomnia but it gets to 3am and I’m taking more pills on top to sleep.
Please see the video on insomnia - if insomnia is due to Hyperarousal or agitation of another sleep disorder then medications may not optimally treat it or the appropriate medication may be needed to target the underlying issue.
They are quite different . We have a video on Vortioxetine bs SSRIs - that should give you an idea of the differences ua-cam.com/video/uuxXpg4Ck6w/v-deo.htmlsi=MfchwQdZAXlIFNku
Agomelatine has a greater effect on true. anxiety with mild depression. Vortioxetine generally has greater effect if moderate - severe depression with anxiety In other words if anxiety is the predominant issue with depression being mild or not present Agomelatine will have a greater effect ( Ps not medical advice )
Yeah, all I know is I'm now 65 years old. In my lifetime, many of these mental illnesses names have changed. It used 2 be called manic depression. But irregardless, I have been imprisoned 4 most of my life due 2 seeking out my own personal choices as a medication &/or relief from the symptoms of these illnesses. Now that I'm old, I guess you can say it's just 2 late now.
I have found that agomelatine, buspirone or mirtazapine have been great for me. I have found that they have been way too better than ssri:s. I was prescribed duloxetine, but i got way too bad stomach pain and my insomnia got worse. I normaly already have insomnia due to adhd.
It is a safe and effective medication in this age group. “The present study provides the first evidence that an 8-week treatment with agomelatine 25-50 mg/d efficiently relieves depressive symptoms and is well tolerated in elderly depressed patients older than 65 years.”
if someone take agomelatine for SSRIs induced emotional blunting. Then after 6 or 7 months of upregulating the melatonin receptors will cause severe downregulation of melatonin receptors when the agomelatine withdrawn occurs. This would caused insomnia and sleep disturbance just like SSRIs downregulate the serotonin receptors in brain .Means one have to sacrifice their sleep or melatonin receptors for restoring the others
@@murphy771 Not at all . I suffered from ssri and till now after 5 years struggling to regain my mental stability in term of mental energy and motivation .
It’s really not possible to say anything specially without actual diagnostic evaluation. REM sleep behaviour disorder should be diagnosed by the neurologist or a sleep physician . Once that’s done the discussion should be with the neurologist about the role of olanzapine.
In my case,I used agomelatin for few days but doesn't feel any joy or happy or pleasent mood but in case of SSRI it has great impact on mood.But for erectile dysfunction/sexual dysfunction problem was great on SSRI
Agomelatine can take 2 months to kick in, it’s much much slower than SSRIs. Also if after the first 2 weeks you feel no effects whatsoever your GP should have increased your dose to 50mg.
Nobody should take tianeptine unsupervised - I'm not a doctor but I'd be suuuper cautious mixing the two, as both a potentially toxic to the liver, lIke both can totally tank your liver. IF you have proper supervision of you liver functions, and are in a country that allows the proper prescription of tianeptine, then proceed with caution Also be careful as tianeptine is an opioid modulator and can cause problems coming off it
thank you for this video sir. but can you explain me why this thing is causing me ED? well not ED I can get erection by stimulling myself. I feel very good on this medication, but for me, its causing numbniness and I have no libido. why it is like that?
It’s difficult to comment specifically as each person has a different range of factors. Please discuss this with your doctor who can provide individualised advice .
hi doc,your knowledge has no limits plz tell me what should i take while on duloxitine to treat night time restlessness N RLS(i have melancholic depression)
@@ayeshanabeel2095 in general - please see the video on insomnia I discuss the options. Some options include ( ps not advice ) as an assessment is needed. RLS - low dose clonazepam , clonidine , prazosin, are agents that reduce hyperarousal. Depending on symptoms of depression if agitation is present low dose antipsychotic are also options. Others include Pregabalin and gabapentin for RLS. Ps not advice . Each of the above agent is used to target specific aspects - hence an assessment becomes very important.
@@ganesht1140 I don't have sleep problem much only I had depression and it taked some time to sleep doctor prescribed me this medicine after that I was sleeping for 12 hours so I stopped that
Combining vortioxetine with agomelatine has been amazing. Vortioxetine has been my go to drug for depression, but my anxiety was off the roof. After adding agomelatine my anxiety has dialed down. I’ve monitored for SS and transaminases. No side effects.
This is most likely to happen when a mixed state is already present. Did you have significant sleep issues in the form of vivid dreams, nightmares, waking up several times. light sleeping ? racing thoughts in the day?
It helps circadian rhythms (when used as a chronobiotic) but is not a silver bullet- you’d also need to do all the usual sleep hygiene eg take the agomelatine at 8pm then turn off all screens, do your wind down routine, get into a not-too warm bed, have room darkened etc. And the most important thing is regardless of your sleep duration, you get up at the same time every day and out into natural sunlight. And eat main meal in morning, not at night (breakfast is a zeitgeber = helps with your body clock), and strenuous exercise every day but not in the 3 hours before bed. (And no caffeine after midday of course) Agomelatine just makes this restoration of circadian rhythm easier, which has a dramatic impact on anxiety, depression and suicidality (better sleep, I mean).
Please help me out, i had been gone to the famous neurologist and it had no result although my symptom matches the symptom of rem sleep behavior. You said that olanzapine may not necesarrily caused rbd. But i have read that antipsychotic can cause rbd. Please tell me more about it😊. Btw i have not slept for 4 days. I'm enough😊 . I have gone to all kind of psychiatrist and neurologist😊 and it has been no use. you are my only help😊 . I'm literally dying😊 please understand me. Thank you best wishes. My face has wrinkle now although i'm still very young. I'm really concerned about my health😊. I also feel wakefulness , i do not take any medication but melatonin and antihistamin.Btw if you are not touched by this i Don't know what will😊. Also if you still suggest me to psychiatrist or neurologist , i'll be fucked. The one who passively let someone suffer is as much the same as someone who gives suffering. Please how can i consult with you instead i Will pay you😊
Sorry can’t provide advice in relation to this as this would be inappropriate. Due to medicolegal reasons consults cannot be provided. Please discuss this with your doctor. Wish you well.
It’s brilliant, for very depressed people, they should start on 50mg not 25mg. For people who can’t tolerate jitters, weight gain, REM sleep suppression, emotional blunting, sexual dysfunction and grogginess from other medications, agomelatine on its own is great. There’s a dreadful habit of psychiatrists prescribing antipsychotics (quetiapine or olanzapine usually) for SSRI-induced insomnia. Olanzapine is not a sleeping tablet! Nobody likes tardive dyskinesia.
Olanzapine and especially Quetiapine almost never causes TD or any of the EPS!... Stop creating fear of these meds!... Aripiprazole, Cariprazine, Brexpiprazole all these considered safe actually causes the most EPS, like Akathisia, anxiety, restlessness, tremors etc.
thanks for your comments. however when critiquing a video and calling it BS it would be helpful to outline the specific errors and outline thr corrections as well.But here is an article that I’ve written that coners the pharmacoDynamics along with references in a lot more detail. psychscenehub.com/psychinsights/agomelatine-mechanism-action/
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Hi Dr. Sanil Rege - Great video! I have a follow up question if you have the time:
1. With a low half-life (1-3 hours) how can Agomelatine function as a potent anti-anhedonic/antidepressant/anxiolytic? With SSRIs we're looking at a SERT occupancy of roughly 80% (except vortioxetine maybe) and we'd expect to achieve steady-state.
With Buspirone, having a similar half-life, one would have to take it a few times a day for it to be effective. I don't think I've ever heard of buspirone once-daily, but then again...who knows.
Is MT1/2 agonism in SCN enough to lead to, say, 24-hr changes in neurotransmitter release and/or changes in certain circuits?
The issue is even more puzzling when it comes to 5HT2C?
Cheers!
The half-life is not directly related to the efficacy or side-effect profiles. In some cases they may in other cases they may not. The best way I can answer this is through an analogy. When we exercise we exercise for a few hours. Only it is the cascade off the biological changes and of course psychological social etc changes that result in the improvement of range of dimensions Subsequently. we might sleep for 6 to 7 hours, but it is the effect of the changes that occurred during that limited time that can have sustained benefits. It’s the same with medication. The medication does not primarily changed the rcognition, activity emotional dimensions. What they do is that they assist in making these changes through a cascade of interactions. Hope this helps answer the question.
@@PsychiatrySimplified Wow - Thank you so much for the fast reply! That makes sense.
Last one if you're enjoying these questions:
SSRIs would eventually downregulate 5H2C via excessive signaling and downregulation.
Would you be concerned about "loss of insensitivity" if you combine an SSRI with Agomelatine, in this case Agomelatine "resensitizing" the 5HT2C receptor?
Although I believe 5HT2C shows no upregulation with antagonism/agomelatine and inverse agonism may be needed for that
Just some food for thought. And would def be interesting to see if any of these receptors-ligand interactions are also mediated by b-arrestins/biased signalling
I used to have horrific vivid nightmares every night. These stopped once I started Agomelatine.
Thanks for sharing 🙏🏻
@PsychiatrySimplified
Why did some papers highlight that AM antagonizes 5HT2B? What’s your take on this? And how does 5HT2B contribute to the efficacy of AM?
The key about melatonin is not necessarily the 5HT2C or B on its own but rather the synergy of both M1-m2 agonist activity PLUS 5HT2C antagonism that is the Difference. “MT1 and MT2 receptors also form heterodimers with the serotonin (5-HT2C) receptor” . 5HT2B may be involved but its this heterodiner that is the postulated mechanism of agomelatine for depression
I take temazapam ad-hoc for sleep anxiety - maybe 25 tablets a year. If I don't sleep I get so anxious I can't sleep the next night so temazapam breaks that cycle. Occasionally my anxiety gets so acute I go on anti depressants. Twice in my life. My anxiety is always about getting to sleep. Would agomelatine be suitable for sleep anxiety? I've taken Zoloft twice in my life - it worked but puts on a lot of weight. Would ago melatine be good for sleep anxiety?
Agomelatine can help with sleep and is also evidence based on anxiety. Please also look at the video on insomnia we did to a get a broader understanding. Ps not medical advice
Follow up.... week 2 on agomelatine. Amazing! Im not over eating. Im not lazy like on zoloft, hitting the gym 3 times a week. No need for benzos. Cured my sleep and general anxiety. Worked in 3 days.
Never touching an SSRI again. Only side effect is ive needed a few naps during the day. Liver tests next week. Fingers crossed! Ill be on this until im over a particularly stressful period of life.
Going up and tapering of zoloft was hell. Going up on agomelatine was bliss. My GP said you can take your benzo but just see if you need it. Give it 2 hrs. I didn't need it. Sleep anxiety gone in 1 day. General anxiety started to blunt in 3 days. This stuff so far is utterly amazing for me.
Can you hypothesize as to why this is beneficial to ocd. I do lots of research on the subject and have used high dose Clomipramine, neuroleptics, fluvoxamine etc. currently using fluvoxamine with moderate benefit
It has some benefit for OCD but not to the extent clomipramine or fluvoxamine would . Agomelatine can help with OCD by improving the PFC control over the arousal and habit parts ( which medicate the compulsions) . It’s also possible that this group may have a mild adhd phenotype comorbid with OCD explaining the result .
This is really informative thank you. I have been recommended to switch from 25mg Sertraline to 25mg Agomelatine. I am sensitive to medications and have found coming off Sertraline harder than expected. What is the best approach to switching?
We can't provide specific advice however switching from sertraline to agomelatine can pose a risk of withdrawals- in such cases one can keep the low dose of sertraline for an extended period Nd attempt to come off when stability is reached if at all. Agomelatine combined with sertealine is an evidence based strategy so there are no issues with this combination and offers a synergy. The clinician can then decide the best steps forward based on the response. With this the withdrawal symptoms are minimised while at the same time depression is treated. Ps not medical advice
@@PsychiatrySimplified Thank you for your reply, I will bring this up with my doctor. Does Agomelatine have much evidence for anxiety as well? Sertraline even at low dose has helped my generalised anxiety, but unfortunately I have experienced slight apathy as well as weight gain, not disabling in terms of the apathy but enough to annoy me. Thanks again.
I will start with Agomelatin next week but I'm a little concerned about the possible liver damage (there have even been a few fatal cases in the past.. ). What does the current study say about this? So far I have found a lot of different information about it. I would also like to know whether it is possible to drink 2 - 3 glasses of wine per WEEK despite a possible increase in transaminase levels..? Of course, alcohol shouldn't have any priority, but when enjoyed among friends and in such small quantities, it is still a part of the quality of life for me.
It is uncommon but there are monitoring recommendations. There have been 6 cases worldwide. “Authors of this review state that liver injury associated with agomelatine is idiopathic and usually reversible. They suggest warning against factors that may increase risk for liver injury (concomitant alcohol consumption). Patients should be counseled that fatigue, nausea, vomiting and dark urine may indicate liver injury and should be reported immediately”.
@@PsychiatrySimplified thanks for your quick response! ❤️
I can only speak from my own experience, but I've been taking this drug for five years now, and my blood tests have always come back strong & healthy. Some people are vulnerable, but it doesn't appear to be common.
As with any drug like this, it's important to remain consistent with check ups & blood tests, but assuming you do that, you'll have nothing to worry about.
Do you think agomelatine would help in long covid for POTS Vestibular migraine causing balance issues fatigue post excercise malaise and over active sympathetic nervous symptom?
Unlikely to target all of the above symptoms as it may need a multipronged approach. It can help milder levels of fatigue and insomnia ( but can worsen sleep in some individuals )
I was on valdoxan but I found it made me very groggy after wakening , I suffer from social anxiety and nothing works for it , I’m on Duloxetine now but again it doesn’t work I spend a lot of my time alone unfortunately
There a few ways around this. 1. Allowing time on Agomelatine as some can have the sedation with the effect waning. 2. If persists - halving the dose. 3. Social anxiety - CBT plus medication has best evidence.
Can venlafaxine be placed next to bupropion and modafinil in the hierarchy? In very high doses from 300 to 375 mg Please reply to me, thank you
Not really. Venlafaxine has 30:1 SERT to NAT so as doses go up even the SERT blockade goes up - which reduces ventral striatal DA. Bupropion has a NAT and DAT blockade and Modafinil has DAT predominantly with histaminergic and orexinogenic potentiation - some NA as well.
@@PsychiatrySimplified I mean its effect on dopamine, not norepinephrine, in very high doses, from 300 mg to 375 mg, and not small clinical doses.
I have been on it for about 4 years Dt...but now my anxiety attacks have returned. Im on 25mg and had aweful effects being on SSRIs and this seemed to help with my panic attacks. My liver function is good....is adding another 25mg/0r half more of the tablet to the current 25mg effective? Im scared to go off it and not many dictors know too much about Valdoxan....please help. Btw...im now told i have Functional Dyspepsia proberly brought on by Anxiety. 😢
When anxiety breakthrough occurs the following aspects should be considered .this is not medical advice 1. Rule out medical conditions 2. Dose of Agomelatine - may have gradually led to activation - increase in anxiety . This occurs more in individuals with mixed states ( so individuals may have hyperarousal and agitation instead of just anxiety. This is important to rule out . 2. The Agomelatine dose may not be sufficient to address the anxiety 3. sSRis worsening panic attacks can point to underlying hyperarousal ( pre existing racing thoughts , insomnia , early morning awakening) - in such situations a buffer ( mood stabiliser or another agent to address the hyperarousal / agitation is needed) is needed to help the antidepressant work better. Please have a look at our video on Mixed features. One doesn’t need to go off Agomelatine if it’s helped - often it’s the mixed states that’s not addressed. It’s a common issue. Insomnia, racing thoughts restlessness that one can’t control are clues
@@PsychiatrySimplified Thank you so much...that is brilliant information. Will see if I can find a psychiatrist that can help with that information. 🙏
Sir can modafinil reverse my anhedonia and low mental energy . The anhedonia and low mental energy caused due to 7 month using of escitalopram for depression. Is there any evidence that modafinil could reverse these issues. Thanks sir
There are multiple agents that have shown that emotional bunting can be treated. Modafinil, armodafinil, bupropion, vortioxetine, agomelatine. Essentially dopaminergic agents. However other symptoms should also be taken into account - for example if an individual is very anxious - a preoccupation Re emotional blunting may require a different approach. Hence it's important to carry out a comprehensive assessment
@@PsychiatrySimplified Thanks sir for the valuable information
I’ve been taking it three weeks and I’ve had no sleeping benefits. ( I was on Vortioxetine for anxiety before . I added agomelatine and had to stop the Vortioxetine because on both I was getting severe nausea ) . I feel the same anxiety wise but would love some sleep. Still relying on benzos and sleeping pills right now. practicing sleep hygiene and doing CBT insomnia but it gets to 3am and I’m taking more pills on top to sleep.
Please see the video on insomnia - if insomnia is due to Hyperarousal or agitation of another sleep disorder then medications may not optimally treat it or the appropriate medication may be needed to target the underlying issue.
Heya, would you be able to do a comparison for this vs vortioxetine in the use of mixed depression & anxiety?
They are quite different . We have a video on Vortioxetine bs SSRIs - that should give you an idea of the differences ua-cam.com/video/uuxXpg4Ck6w/v-deo.htmlsi=MfchwQdZAXlIFNku
@@PsychiatrySimplified Thank you Dr!
I am curious based on your experience, does one seem to be more effective on anxiety than the other?
Agomelatine has a greater effect on true. anxiety with mild depression.
Vortioxetine generally has greater effect if moderate - severe depression with anxiety
In other words if anxiety is the predominant issue with depression being mild or not present Agomelatine will have a greater effect ( Ps not medical advice )
@@PsychiatrySimplified Thank you for sharing your thoughts :)
Yeah, all I know is I'm now 65 years old. In my lifetime, many of these mental illnesses names have changed. It used 2 be called manic depression. But irregardless, I have been imprisoned 4 most of my life due 2 seeking out my own personal choices as a medication &/or relief from the symptoms of these illnesses.
Now that I'm old, I guess you can say it's just 2 late now.
Does it cause emotional blunting/numbness?
significantly lower risk and is used to treat SSRI induced emotional blunting
@@PsychiatrySimplified Thank you very much Dr. ,Much appreciated!
What about its efficacy?
It's has good efficacy in depression and anxiety. It is likely to need augmentation at the severe ends of the depressive spectrum.
I have found that agomelatine, buspirone or mirtazapine have been great for me. I have found that they have been way too better than ssri:s. I was prescribed duloxetine, but i got way too bad stomach pain and my insomnia got worse. I normaly already have insomnia due to adhd.
Hi , thanks a lot for this wonderful presentation. What about the elderly people?
It is a safe and effective medication in this age group. “The present study provides the first evidence that an 8-week treatment with agomelatine 25-50 mg/d efficiently relieves depressive symptoms and is well tolerated in elderly depressed patients older than 65 years.”
Can agomelatine be combined? With mirtazapine.
Yes - for the right reasons.
if someone take agomelatine for SSRIs induced emotional blunting. Then after 6 or 7 months of upregulating the melatonin receptors will cause severe downregulation of melatonin receptors when the agomelatine withdrawn occurs. This would caused insomnia and sleep disturbance just like SSRIs downregulate the serotonin receptors in brain .Means one have to sacrifice their sleep or melatonin receptors for restoring the others
So, isn't it reversible at all?
@@murphy771 Not at all . I suffered from ssri and till now after 5 years struggling to regain my mental stability in term of mental energy and motivation .
@@SM-by8mg- Hi, How are doing now? Are you taking anything at the moment?
@@intermilan6202 No dear . I only take natural supplements like fish oil, Vitamin B complex and l thyphtophan etc. Also took SJW for a month.
@@intermilan6202 I took St john wort for a month and now i am taking L thyrosine .
Not available in the US. Damn.
Sir please tell me more about olanzapine associated rem sleep behavior disorder please.
It’s really not possible to say anything specially without actual diagnostic evaluation. REM sleep behaviour disorder should be diagnosed by the neurologist or a sleep physician . Once that’s done the discussion should be with the neurologist about the role of olanzapine.
Excellent video
Thank you 🙏🏻
It is unfortunate that agomelatine is not on the PBS. Meanwhile, IVF medications like Luveris ($1,300 per course) are on PBS.
Yes it’s unfortunate. Same with Vortioxetine
But shop around, ask chemist warehouse to order Lupin brand it’s $40- far cheaper than the generic and half the price of the valdoxan
In my case,I used agomelatin for few days but doesn't feel any joy or happy or pleasent mood but in case of SSRI it has great impact on mood.But for erectile dysfunction/sexual dysfunction problem was great on SSRI
Thanks for sharing. Yes sexual dysfunction is an issue with SSRI
Agomelatine can take 2 months to kick in, it’s much much slower than SSRIs. Also if after the first 2 weeks you feel no effects whatsoever your GP should have increased your dose to 50mg.
Regardless of what time I took this medicine, I always woke up at 230AM and couldn't fall back to sleep.
Experienced similar effect. Wakeup at 2.30 and can't fall back to sleep
Can I take it with stablon( tianeptine)?
Nobody should take tianeptine unsupervised - I'm not a doctor but I'd be suuuper cautious mixing the two, as both a potentially toxic to the liver, lIke both can totally tank your liver. IF you have proper supervision of you liver functions, and are in a country that allows the proper prescription of tianeptine, then proceed with caution
Also be careful as tianeptine is an opioid modulator and can cause problems coming off it
@@90klh thank you so much
thank you for this video sir. but can you explain me why this thing is causing me ED? well not ED I can get erection by stimulling myself. I feel very good on this medication, but for me, its causing numbniness and I have no libido. why it is like that?
It’s difficult to comment specifically as each person has a different range of factors. Please discuss this with your doctor who can provide individualised advice .
hi doc,your knowledge has no limits
plz tell me what should i take while on duloxitine to treat night time restlessness N RLS(i have melancholic depression)
@@ayeshanabeel2095 in general - please see the video on insomnia I discuss the options. Some options include ( ps not advice ) as an assessment is needed. RLS - low dose clonazepam , clonidine , prazosin, are agents that reduce hyperarousal. Depending on symptoms of depression if agitation is present low dose antipsychotic are also options. Others include Pregabalin and gabapentin for RLS. Ps not advice . Each of the above agent is used to target specific aspects - hence an assessment becomes very important.
I am taking it for 9 days i am sleeping for 12 hours i am going to stop it from today only take ssri
Did you have severe sleep problem?
What was the reason for your insomnia?
@@ganesht1140 I don't have sleep problem much only I had depression and it taked some time to sleep doctor prescribed me this medicine after that I was sleeping for 12 hours so I stopped that
I took it for emotional blunting treatment but it didn't work for me 😞😞
SSRI induced ? With or without SSRI if the former.
@@PsychiatrySimplified
I was on Anafronil
How long did you use it? What dose? It's important!
@@mauriciojr.4428 about 2 moths on 25mg
Did you try it for 9-12 months? It’s far slower to kick in than SSRIs and SNRIs
Combining vortioxetine with agomelatine has been amazing. Vortioxetine has been my go to drug for depression, but my anxiety was off the roof.
After adding agomelatine my anxiety has dialed down. I’ve monitored for SS and transaminases. No side effects.
Thanks for sharing! That’s really helpful to hear your experience
I was on vortioxetine and started agomelatine but I felt nauseas on both. I stopped the vortioxetine and the nausea went
it fucked up my sleep so badly that i was depressed and irritated all day long after taking it. It didn't work for me
This is most likely to happen when a mixed state is already present. Did you have significant sleep issues in the form of vivid dreams, nightmares, waking up several times. light sleeping ? racing thoughts in the day?
@@PsychiatrySimplified to be honest maybe light sleeping but none of the others. And yes, it's mixed, i have anxiety and depression too
It helps circadian rhythms (when used as a chronobiotic) but is not a silver bullet- you’d also need to do all the usual sleep hygiene eg take the agomelatine at 8pm then turn off all screens, do your wind down routine, get into a not-too warm bed, have room darkened etc.
And the most important thing is regardless of your sleep duration, you get up at the same time every day and out into natural sunlight. And eat main meal in morning, not at night (breakfast is a zeitgeber = helps with your body clock), and strenuous exercise every day but not in the 3 hours before bed.
(And no caffeine after midday of course)
Agomelatine just makes this restoration of circadian rhythm easier, which has a dramatic impact on anxiety, depression and suicidality (better sleep, I mean).
Please help me out, i had been gone to the famous neurologist and it had no result although my symptom matches the symptom of rem sleep behavior. You said that olanzapine may not necesarrily caused rbd. But i have read that antipsychotic can cause rbd. Please tell me more about it😊. Btw i have not slept for 4 days. I'm enough😊 . I have gone to all kind of psychiatrist and neurologist😊 and it has been no use. you are my only help😊 . I'm literally dying😊 please understand me. Thank you best wishes. My face has wrinkle now although i'm still very young. I'm really concerned about my health😊. I also feel wakefulness , i do not take any medication but melatonin and antihistamin.Btw if you are not touched by this i Don't know what will😊. Also if you still suggest me to psychiatrist or neurologist , i'll be fucked. The one who passively let someone suffer is as much the same as someone who gives suffering. Please how can i consult with you instead i Will pay you😊
Sorry can’t provide advice in relation to this as this would be inappropriate. Due to medicolegal reasons consults cannot be provided. Please discuss this with your doctor. Wish you well.
@@PsychiatrySimplified i can understand that , i guess i'm just gonna wait for death then
It’s brilliant, for very depressed people, they should start on 50mg not 25mg.
For people who can’t tolerate jitters, weight gain, REM sleep suppression, emotional blunting, sexual dysfunction and grogginess from other medications, agomelatine on its own is great.
There’s a dreadful habit of psychiatrists prescribing antipsychotics (quetiapine or olanzapine usually) for SSRI-induced insomnia. Olanzapine is not a sleeping tablet!
Nobody likes tardive dyskinesia.
Olanzapine and especially Quetiapine almost never causes TD or any of the EPS!... Stop creating fear of these meds!... Aripiprazole, Cariprazine, Brexpiprazole all these considered safe actually causes the most EPS, like Akathisia, anxiety, restlessness, tremors etc.
Half life of 1-2 hours, DA/NA enhancement is bull shit, author must study before making video
thanks for your comments. however when critiquing a video and calling it BS it would be helpful to outline the specific errors and outline thr corrections as well.But here is an article that I’ve written that coners the pharmacoDynamics along with references in a lot more detail. psychscenehub.com/psychinsights/agomelatine-mechanism-action/