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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SLS on January 14, 2011, at 13:39:42
Hi.
Agomelatine (Valdoxan) and Iatrogenic Pain Syndromes.
I began taking agomelatine a few weeks ago. Everything in my body hurts. I stoop like an old man when getting out of a chair. At times, the pain is random in its location throughout the body. If I favor one arm, the other one begins to hurt.
Should I continue with agomelatine? It is a difficult decision to make. Because agomelatine has no extensive track record for its usage, I doubt that all of the adverse events for this drug have been observed, recognized, and recorded. However, I know someone for whom the addition of agomelatine produced a remarkable resolution of his bipolar rapid cycling mood disorder.
Has anyone else experienced the appearance of pain upon agolemlatine administration?
Did the pain disappear with continued usage and the passage of time?
Thanks.
- Scott
Posted by Bob on January 14, 2011, at 16:02:07
In reply to Agomelatine (Valdoxan) and Body Pains?, posted by SLS on January 14, 2011, at 13:39:42
Scott -
I have a sordid history of iatrogenic pain syndromes from various treatments which started in earnest about 5 years ago.
First was ECT, which produced the kind of strange pains you are talking about, especially in my hands, back, neck and shoulders. ECT produced good effects as well, so I continued with it and the pain got worse.
Then there was my response to atypical antipsychotics. I learned over time that although there was an initial benefit with elevated mood and energy, the response would devolve into irritability and joint pain. The pain appeared in my knees, hands and arms. The higher the dose the worse the pain became.
Last is an experimental treatment trial I was involved in for the last few years, the details of which I'd rather than divulge right now. Here too, pain began emerging as treatment progressed. Similar to the AAPs and ECT, there were significant benefits as well, so again I pushed it. Pain got worse and chronic.
There is a truly mysterious link between this pain syndrome I have and my depression that is not understood by me, and neither has it been understood by any of my doctors. It is truly confounding and scary. So having said that, I would not be surprised in the least if agomelatine was producing the pain you describe. I wish I knew what to say about continuing treat. Unfortunately as much as I hate to admit it, I do not recall an effective treatment where pain was present initially and then subsided. I would say SSRIs, but they have never been too effective for me.
Bob
Posted by SLS on January 14, 2011, at 18:02:45
In reply to Re: Agomelatine (Valdoxan) and Body Pains?, posted by Bob on January 14, 2011, at 16:02:07
Hi Bob.
> Then there was my response to atypical antipsychotics. I learned over time that although there was an initial benefit with elevated mood and energy, the response would devolve into irritability and joint pain. The pain appeared in my knees, hands and arms. The higher the dose the worse the pain became.Exactamundo! I have also been irritable over the last week.
> There is a truly mysterious link between this pain syndrome I have and my depression that is not understood by me, and neither has it been understood by any of my doctors.
Any PTSD history?
> It is truly confounding and scary. So having said that, I would not be surprised in the least if agomelatine was producing the pain you describe.
I skipped my nightly dose of agomelatine yesterday. The pain has subsided a great deal today, and my mood has improved. It appears that, for me, agomelatine is mildly depressive. This has been my second trial of agomelatine. Just like with the first one, the appearance of depressive side effects compelled me to abort the trial. My mother swears that I had complained of pain during my first trial. I really don't remember.
> I wish I knew what to say about continuing treat. Unfortunately as much as I hate to admit it, I do not recall an effective treatment where pain was present initially and then subsided.
That is the sort of information I was looking for.
Thanks much.
I really hope that you find an effective treatment soon.
I think we both know that finding a treatment regime that hits the target such as to produce a full remission could involve a lengthy series of clinical experiments. I am working toward finding a middle ground where I am improved enough to return to work while remaining motivated enough to continue searching for better treatments. The trick here is not to break what you have already fixed for the sake of putting more pieces together. I have settled on taking four different drugs consistently as a treatment regime in order to function well enough to get a job. I am tentatively looking at late spring or summer to begin applying for jobs. Between now and then, I may want to undergo a series of rTMS treatments while remaining on medication. The process would take at least four weeks, five days a week.
rTMS
$400 per treatment
1 treatment per day
5 days per week
4 week protocol$8000 for the initial series of 20 treatments
$400 x ? maintenance treatments per year
If Medicare were to approve rTMS tomorrow, I would be in the treatment chair later that day.
I probably will not consider trying vilazodone when it first becomes available. For me to try vilazodone would require that I discontinue Nardil. After the drug has been out for awhile, we ought to get a better idea as to how effective it is and what subtypes of MDD and BD it is best suited for. The evidence would have to be very compelling before I risk employment to try it.
- Scott
Posted by Bob on January 14, 2011, at 19:58:57
In reply to Re: Agomelatine (Valdoxan) and Body Pains? » Bob, posted by SLS on January 14, 2011, at 18:02:45
Ironically, I was going to mention that heightened pain has also often gone hand-in-hand with extreme irritability for me. So it doesn't surprise me that you mentioned it as well.
I don't have a PTSD diagnosis or an event I could point to in my life that would recognizably cause such a thing, but I've often thought that certain aspects of my illness are very close to what PTSD sufferers describe. My condition is permeated with a significant level of GAD and when I get worse this, along with what I call "intrusive rumination" and an exaggerated startle reflex are exhibited prominently. It's like my brain gets re-traumatized. I guess it also elucidates the significant overlap that is present in the various subtypes of mental illness.
"The trick here is not to break what you have already fixed for the sake of putting more pieces together."That indeed is a trick - a situation which I've always intellectually been aware of but didn't give as much credence to in the early years as I think I'm inclined to now. Back then I couldn't bear the thought that just a simple tweak of this or that would get me back to 100%. I've lost most of that feeling these days and I don't know whether it is due to an overall reduced response to anything I try anymore, or maybe the experience I've gained with all the painful failures. I tend to think the former is more likely the case. If you get a decent response to something, it would logically embolden you to try for that last stretch. There's that feeling that one is so close and that some small change will close the gap and all this can be put in the past. A very slippery slope indeed.
Where would you try to get rTMS?
You mention how you probably wouldn't try vilazadone because it would require you to discontinue Nardil. This is a very familiar quandary to me since at this point tapering off current meds would be highly destabilizing. I read about a drug in development considered to be a RIMA that sounds interesting as it naturally would be hitting the three main monoamines at a minimum, but I don't know if I would survive a situation where I have to taper off my current regime only to find out that the drug is intolerable (or worse) for me. Like you said, "the evidence would have to be very compelling".
I sometimes have distant fantasies of returning to work in some capacity, but it doesn't seem within reach for me these days. I hope the best for in this regard however. It would be very reassuring to achieve such a goal. That goes for any treatment out there really.
Bob
Posted by Phillipa on January 14, 2011, at 22:22:27
In reply to Re: Agomelatine (Valdoxan) and Body Pains? » SLS, posted by Bob on January 14, 2011, at 19:58:57
Maybe with rTMS if approved a washout of all the old meds and begin anew. Requip totally with a bit of desipramine, some vyvanase, and a bit tiny bit of zyprexa have worked wonders and allowed an attorney that used to post here to marry, be expecting a child, and return to law and has rebuilt his practice. I know he tweeks his meds and if in a day or so notices anything negative returns to previous doses of meds. So as chemistry changes and I personally feel aging of the liver determines how some meds may react in a person's body. By no means am I an expert. I just go with the flow and listen, read a lot and even have found what the dentist who is doing my crowns told me that sometimes people on SSRI's grind their teeth. Phillipa
Posted by Ron Hill on January 17, 2011, at 11:09:34
In reply to Agomelatine (Valdoxan) and Body Pains?, posted by SLS on January 14, 2011, at 13:39:42
Scott,
> I began taking agomelatine a few weeks ago. Everything in my body hurts. I stoop like an old man when getting out of a chair. At times, the pain is random in its location throughout the body. If I favor one arm, the other one begins to hurt.So sorry that Valdoxan did not work out. You gave it a fair try via your two trials.
As you know, Valdoxan stopped my bipolar ultra rapid cycling and, as a result, my depressive phases no longer occur. The one caveat is that if I forget to take my vitamins and supplements for two or more days in a row, I become dysthymic and very sleepy-tired during the day. Within a couple of hours after resuming my vitamins and supplements, I become completely well again.
As you also know, I added Valdoxan to my combo on 8/4/10 and it continues to work today. I had four nights of nightmares and vertigo as start-up side effects. As shown at the bottom of this page, I currently take 12.5 mg/night of Valdoxan.
After 14.5 years of trying to stop my ultra rapid cycling, I am thankful beyond description that I am finally well. Scott, I wish with all my heart that you find wellness soon.
I also wish that everyone on PB will find full relief for their particular disorder. I know the pain and I wish that relief would be provided for all.
If it were not for PB and the people that post here, I'm not sure that I would have ever found the cocktail that has made me well.
Scott, sorry to step on your thread. I just wanted to let the record show that while Valdoxan does not help everyone, it does provide good benefit to some.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal (oxcarbazepine)
200 mg/day Lamictal (lamotrigine)
500 mg/day Keppra (levetiracetam)
90 mg/day Nardil (phenelzine)
12.5 mg at betime Valdoxan (agomelatine)
3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
2.5 mg/day Adderal XR45 ml/day of Carlsons Bottled Fish Oil
200 mg/day phosphatidylserene
One Multi-vitamin/day; Only 100% of all the usual vitamins; Look for good chelations. NO VANADIUM!!
2000 IU/day Vitamin D-3
850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
200 mcg/day GTF Chromium
600 mcg/day Chromium Picolinate
200 mg/day Co-Q10
1000 mg/day Cinnamon
480 mg/day Milk Thistle
2 g Vitamin C
Whats next to add?:
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid
Posted by g_g_g_unit on January 18, 2011, at 18:18:08
In reply to Re: Agomelatine (Valdoxan) and Body Pains? » SLS, posted by Ron Hill on January 17, 2011, at 11:09:34
My doctor offered to prescribe Agomelatine for sleep, as it's recently been approved in Australia . .
I'd read it can be a little on the stimulating side, though . . is anyone here anxiety prone? If so, can you comment on that side of things?
This is the end of the thread.
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