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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by JohnWatford on April 19, 2016, at 17:36:21
For depression and anxiety, I am on lexapro 20 having gradually built up slowly from 5 to 10 to 15 mg over last 10 weeks. Have been on 20 mg for only two weeks. Have a response of sorts but not fully and feel a bit yuck each morning after taking the med. GP suggested taking nortriptylene at night as well as this is weak on seratanonin impact - does not conflict with SSRI. Started on 10 mg at night, will increase to 20 and maybe eventually to 50. Reading good things about valdoxan. Would it be good to add this to the mix? I don't want to drop lexapro and start a new SSRI as I had a lot of side effects building up slowly to 20 mg last two months.
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Posted by Tomatheus on April 19, 2016, at 23:17:29
In reply to Escatilopram with Nortriptylene and Valdoxan, posted by JohnWatford on April 19, 2016, at 17:36:21
Hello, and welcome to Psycho Babble. My opinion on your situation is that giving the two medications that you're currently taking some time to determine what their effects will be after a few more weeks or so would make the most sense, as long as you're not in a crisis, and as long as you're not experiencing any adverse effects that might prompt your doctor to make some changes to your medication regimen. I definitely think that it would be best to evaluate how taking nortriptyline along with Lexapro will affect you a little further down the line before putting too much thought into adding a third medication into the mix.
As far as my thoughts on Valdoxan are concerned, I tend to think that the medication would likely be more beneficial for individuals who have trouble staying asleep and might also have problems with waking up too early, as compared to individuals who sleep excessively and tend to have a lot of difficulty waking and getting out of bed. One of the things that Valdoxan does is basically mimic the effects of the hormone melatonin at two of the receptor sites that the hormone binds to, and melatonin is secreted when we're exposed to darkness and is thought to help regulate sleep. Valdoxan also has pharmacological actions that don't involve the melatonin system, such as blocking one of the serotonin receptors, the 5HT2C receptor. I haven't taken Valdoxan, but I have taken melatonin supplements, and those seemed to worsen my depressive symptoms. I should note that I sleep excessively and have a difficult time waking up and getting out of bed due to extreme morning fatigue when I'm not responding well to treatment, and melatonin basically made these problems worse.
What does your sleep look like, particularly when you're not receiving or responding to treatment?
Tomatheus
Posted by JohnWatford on April 20, 2016, at 3:34:27
In reply to Re: Escatilopram with Nortriptylene and Valdoxan » JohnWatford, posted by Tomatheus on April 19, 2016, at 23:17:29
> Hello, and welcome to Psycho Babble. My opinion on your situation is that giving the two medications that you're currently taking some time to determine what their effects will be after a few more weeks or so would make the most sense, as long as you're not in a crisis, and as long as you're not experiencing any adverse effects that might prompt your doctor to make some changes to your medication regimen. I definitely think that it would be best to evaluate how taking nortriptyline along with Lexapro will affect you a little further down the line before putting too much thought into adding a third medication into the mix.
>
> As far as my thoughts on Valdoxan are concerned, I tend to think that the medication would likely be more beneficial for individuals who have trouble staying asleep and might also have problems with waking up too early, as compared to individuals who sleep excessively and tend to have a lot of difficulty waking and getting out of bed. One of the things that Valdoxan does is basically mimic the effects of the hormone melatonin at two of the receptor sites that the hormone binds to, and melatonin is secreted when we're exposed to darkness and is thought to help regulate sleep. Valdoxan also has pharmacological actions that don't involve the melatonin system, such as blocking one of the serotonin receptors, the 5HT2C receptor. I haven't taken Valdoxan, but I have taken melatonin supplements, and those seemed to worsen my depressive symptoms. I should note that I sleep excessively and have a difficult time waking up and getting out of bed due to extreme morning fatigue when I'm not responding well to treatment, and melatonin basically made these problems worse.
>
> What does your sleep look like, particularly when you're not receiving or responding to treatment?
>
> Tomatheusthank you so much for responding - this is my first time on a chat forum so to speak so I am very happy somebody came forward. Interestingly, today, it seems the 20 mg escitalopram finally kicked in. This is the first day that my depression and anxiety have diminished significantly - but I am not sure it is simply just a "one off". Anyway, I am still on 10 mg Nortrip (therapeutic dose is minimum 50 mg subject to blood tests which is a few weeks away). But I am feeling so much better today and I feel when I see my doctor in 12 days I will maybe drop the Nortrip. On sleep, I wake up several times a night - love my sleep - and have short cat naps during the day. I have no problem (physically) getting out of bed in the morning - but when one is depressed, it is better to just lie in bed. i might wake at 0530 but I just stay in and and "veg" until 0700 when I just jump out of bed as I know it is wrong to stay. I ride my bike every day too (and drink wine which is, I know, not good). But this is the first day I am coping after a horrendous time getting used to escitalopram. If I could feel this way every day I would call it a miracle drug but the the 14 weeks to get here have been hell! I think the lexapro probably works for everybody but people just give up early as the side effects like increased anxiety are so horrible.
Posted by JohnWatford on April 20, 2016, at 3:38:20
In reply to Re: Escatilopram with Nortriptylene and Valdoxan, posted by JohnWatford on April 20, 2016, at 3:34:27
sorry I forgot to mention one of my concerns with Valdoxan is impact on liver
Posted by Tomatheus on April 20, 2016, at 12:04:07
In reply to Re: Escatilopram with Nortriptylene and Valdoxan, posted by JohnWatford on April 20, 2016, at 3:34:27
John,
Thank you for your reply to what I wrote. I'm very glad to hear that you noticed some improvement as of earlier today, and I most certainly hope that the feelings of well being that you've been experiencing for what's probably still been less than a day now will continue for an extended period of time. I definitely think that there's something to be said about the value of giving medications enough time to exert their longer-term effects, assuming that the startup side effects are bearable enough to get through. I personally wouldn't go as far as to suggest that Lexapro probably works for everyone, as the clinical trials that have been done with the medication suggest that this isn't the case, but I do think that it's the case that some who might experience long-term benefits from a medication do sometimes discontinue the medication in question earlier than they probably should, thus leaving the question as to whether they might respond well to the medication in the long run unanswered. At any rate, it looks like "sticking it out" through what were probably the worst of the startup side effects that you experienced as part of your Lexapro trial is serving you well at this point in time, and I hope that it will be the case that your treatment regimen will continue to serve you well for at least some time.
Tomatheus
Posted by JohnWatford on April 20, 2016, at 19:54:13
In reply to Re: Escatilopram with Nortriptylene and Valdoxan » JohnWatford, posted by Tomatheus on April 20, 2016, at 12:04:07
Thanks - I may have written too early as have had a bit of a setback today - so maybe there are good days and bad days - and I will continue with the nortriptylene for now
Posted by SLS on April 21, 2016, at 0:12:14
In reply to Re: Escatilopram with Nortriptylene and Valdoxan, posted by JohnWatford on April 20, 2016, at 19:54:13
Most people need a minimum of 75 mg/day of nortriptyline. I was taking 150 mg/day for quite some time, but I am a rapid-metabolizer. This is not unusual, though. Taking a test for nortriptyline blood levels will act as a guide to help determine what dosage you should be taking.
- Scott
Posted by TriedEveryMedication on April 22, 2016, at 1:59:40
In reply to Escatilopram with Nortriptylene and Valdoxan, posted by JohnWatford on April 19, 2016, at 17:36:21
a meta-analysis of valdoxan suggests it is a pretty poor AD.
a 0.24 effect size can be conceptualized like this: If you were shown a the test results of someone in the study, you'd only have a 55% chance of guessing that person was taking the valdoxan and not the placebo.
http://www.jwatch.org/na34076/2014/03/31/agomelatine-effective-antidepressant
Posted by SLS on April 22, 2016, at 5:08:13
In reply to Valdoxan didn't fair too well in studies » JohnWatford, posted by TriedEveryMedication on April 22, 2016, at 1:59:40
> a meta-analysis of valdoxan suggests it is a pretty poor AD.
>
> a 0.24 effect size can be conceptualized like this: If you were shown a the test results of someone in the study, you'd only have a 55% chance of guessing that person was taking the valdoxan and not the placebo.
>
> http://www.jwatch.org/na34076/2014/03/31/agomelatine-effective-antidepressantInterestingly, I know someone whose rapid-cycling bipolar disorder was stabilized on valdoxan. After it was added to his other medication, it prevented him from cycling and left him feeling normal. This is just one person, though.
- Scott
Posted by phidippus on May 6, 2016, at 6:14:01
In reply to Escatilopram with Nortriptylene and Valdoxan, posted by JohnWatford on April 19, 2016, at 17:36:21
All Valdoxan does is increase melatonin and antagonize 5ht2c receptors so that norepenephrine and dopamine are released in the frontal cortex. I consider it a weak drug.
Eric
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