Valdoxan or Agomelatine for Depression

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Valdoxan or Agomelatine: A new depression treatment

About 40-50% of people taking the current antidepressants, or the SSRIs, stop treatment shortly after starting.  This is because that class of medications has certain significant side effects, like nauseua and sexual dysfunction.

Valdoxan, generic agomelatine, is a new medication that is generating a lot of excitement because it seems to be an effective antidepressant that doesn’t have those problems.

Valdoxan is a synthetic analogue to melatonin, a natural substance your body has that plays a role in sleep regulation.  Chemically, it serves to activate the melatonin 1 and 2 receptors, while also acting as an antagonist to 5-Ht2.  This latter activity may serve to promote release or norepinephrine and dopamine.

It’s important to note that Valdoxan has significantly different chemical action than the selective serotonin reuptake inhibitors (SSRIs).

Possible Advantages

Valdoxan may not have the same rate or degree or type of side effects as traditional antidepressants. It may not cause nausea, sexual dysfunction and other common side effects.

It may start working faster, with some efficacy observed at just two weeks, not the four typically needed for antidepressants.

Both these elements may mean that people will be less likely to want to stop taking it and could start expereincing benefit at an earlier time.  In some studies, only 15% stopped use of Valdoxan, which is much less than the rate traditional antidepressants have.

This may mean a very significant advantage over traditional treatment.

Concerns

Several studies of Valdoxan have not shown significant advantage over placebo.

Because Valdoxan is heavily metabolized by the liver, people with some form of liver damage may experience toxicity.  One study showed that some degree of liver impairment could lead to a 50-fold increase in drug concentration.

Valdoxan may, like the SSRIs, increase risk of suicidal ideation.

Efficacy

The number one question people have about any medication is, how well does it work?  It appears that there have been 7 major studies to date which have analyzed the efficacy of Valdoxan for treating depression, and there are others going on to see if it works for generalized anxiety disorder and other conditions.

Positive studies

One study showed that Valdoxan was significantly more effective as a treatment for depression than Prozac.

A study of 711 people treated for depression showed that it was significantly better than placebo and had effect starting at 2 weeks.  Additionally, that study showed that severely depressed people were more likely to respond to Valdoxan than to Paxil.

Another study of 238 people showed a roughly 55% response rate versus 35% response to placebo.

Negative Studies

Several have also shown little or no benefit over placebo.  An unpublished 6 week long study of 414 patients showed that Valdoxan had a response in 53% of those taking it compared to 47% who responded to placebo.  That same study showed that Prozac did have a significant response.

And another 6 week long study of 607 patients showed that neither Valdoxan or Prozac had benefit for treating depression over placebo.

What it means

Valdoxan is not free from the problems that typical antidepressants have, that sometimes they don’t seem to work much better than placebo.  The studies seem to indicate that it is about as effective as traditional antidepressants while having significantly less side effects and possibly faster onset of action.

These advantages may make it extremely popular.  That said, the concerns around its metabolism have yet to fully be addressed, and there may be other issues that time will reveal.

Antidepressants

There is a lot of controversy around antidepressants.  Antidepressants – the Pros and Cons looks at both sides of the story.

Treatment Resistant Depression

Sometimes depression does not respond to treatment.  Here we present 10 ideas for Treating Treatment Resistant Depression.

Dealing with Anxiety

Depression and anxiety tend to come together.  See The Top 25 Anxiety Tips for ideas on how to deal with anxiety.

54 COMMENTS

  1. Hi there,
    I have been trawling the web looking for insight into a possible side effect from Valdoxan of really vivid sexual dreams. I came across this site and have been reading many posts. I am 7 days into my prescription for Valdoxan 50mg, the first time I have sought help for my melancholic depression. I have entered into this journey of medication and psychologist counselling with an open mind and after spending well over ten years believing that I could push through without assistance, I have chosen to believe that life is about more than just pushing through and struggling day to day. Having an open mind has made a big difference to my attitude towards medication and I am putting my faith in my GP in his recommendation that Valdoxan will target many of my symptoms (binge eating, bouts of insomnia, feelings of hopelessness and a general lack of feeling) and I appreciate that he was honest in saying that no drug is a miracle cure and hoping for one is irresponsible. I have slept soundly for the past six nights, dropping off within 15 minutes of taking the pill and waking up clear. By no means am I bounding out of bed but really, a sound sleep and no grogginess in the morning is enough for me to not desperately crave the need to be bouncy. I have also noticed that my appetite is reducing significantly which for me is a god send because I am a textbook comfort eater and not constantly gorging to fill a hole is helping my self esteem which again is a positive. I am aware that this drug is not on the PBS (Australia) and I am paying a lot by again, an open mind that if I am prepared to pay for this medication then I am going to give it a real go. I have given up my favourite self medication of alcohol to allow my liver every chance to not be affected by Valdoxan which again has to be a positive right?
    The only thing I am really noticing is the vivid dreams that are sexual in nature.. I am not going to let this one abnormal reaction stop me though and I will be brutally honest about the content of these dreams with my psychologist, all in keeping with an open mind. I understand that no drug is the perfect fit for everyone because we are all unique human beings with intrinsically different biopsychosocial experiences but I implore people to only take others experiences as just that, their own and come at treatment with an open mind to the possibility that perhaps our attitudes need to change from demanding the perfect fit from medical professionals to observing what it is we really want to change about our symptoms and taking the little wins where we can get them.
    I wish you all every luck in your journey with utmost respect for each and every experience x

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