# Agomelatine and tianeptine - experiences of combination treatment



## teddy (Sep 4, 2010)

Hi everybody,

When I started to read through social anxiety forums, SAS instantly felt like a good source of both information and support. It is only, now, after several months of being here, however, that I decided to contribute. Below you can read about some of preliminary experiences with agomelatine and tianeptine combo treatment in case the info might be useful to someone (my first post on any forum of this kind, nervous :teeth).

I find it easier to relate my experiences with this combo by also giving some background information about my condition and my experiences with my previous medication. If you would prefer just reading about my subjective experiences on tianeptine and agomelatine combination treatment (and would rather avoid being embarrassed for me relating my intimate stuff on the sexual side effects of my previous medication and existential angst), only read part B.

*A) Background *

I have suffered from moderate to severe depression for a bit over two years. At its worst this, meant nights and evenings full of suicidal thoughts (not because of some immediate and acute "mental pain", but because of the nagging conviction the life has nothing better to give me than what I am experiencing now - and that now that the bulk of the experience of living is decidedly negative rather than positive, the logical and rational conclusion would be to end it). These feeling have been more common some times and less common sometimes, but they have been present for the past two years, and still are to some extent.

I have tried various kinds of medication:

1) 
First SSRIs. Escitalopram (Cipralex), Venlafaxine (Generic) and a few others. All were moderately effective, but the sexual side effects (erection ok, but _total_ anorgasmia :bash) were too much to bear, even with the standard starting dose (2x5mg for cipralex, can't remember the dose for others).
​ Treatment period with SSRIs: ~5 months.

2) 
Then I ventured on to MAOIs, such as moclobemide (Aurorix). No side effects, but no observable positive effects either even on 600mg daily dosage, and not even when augmented with thyroxine.

Treatment period with MAOIs: ~4 months (should've quitted earlier, but I guess I did not trust enough in my own ability to observe the effects and only listened to my psychiatrist).

3) 
This is when I came up with _the_ old school medicine, cannabis. I had smoked a few times in my life before for giggles and laugh, but now I actually noticed that it helped for my depression. So, I started smoking 1-3times a week. Sometimes even 5 times a week, but mostly 2-3 times a week. The only problem with this is that the relief cannabis provides is a really on-the-spot kind, and naturally it does not help me to work. =) Plus, admittedly, I am a bit afraid.

I know, it is partly irrational, but the identity category of "drug user" belonging to me causes no small amount of anxiety, especially since I feel that my gf deep down disapproves even though she is very nice and supporting otherwise. I told my psychiatrist(s) about this and she (she, and the previous one) basically ok'd it, with some caveats. Mainly that I "shouldn't take it every day" and that I should "beware the sense of being addicted". I guess she meant that a dependency formation with cannabis is much stronger than with the kind of non-addictive prescription drugs I have so far tried (which, unfortunately, I feel is true for me based on my own experience) and that it would be good for my psyche to be able to feel that I could be without the cannabis.

And for sure, the thought of living completely without cannabis feels more difficult than living completely without alcohol, for example. Then again, I never liked to drink much and/or often. But in any case, already at this point I know what she meant, because I would not want to be without cannabis anymore now that I have discovered it. Then again again, when I try to think as objectively as I can, I don't think cannabis has deteriorated the quality of my work, but rather helped me to bear with the depression (that IS significantly hampering my life and work, and, for example, ruining this working day by having me writing this for hours).

Treatment period with cannabis: ~1 year and ongoing&#8230;

4) 
Anyway, after MAOIs I tried Mirtazapin (Remeron), 2x 15mg => 2x 30mg. => 2x 45mg daily. First, no effect. Then a similar, moderately effective (SSRI strength). This was closest to a simple mood boosting effect I have experience - it just increased "baseline mood" somewhat and dulled and cut the worst edge off from negative experiences. But with these higher doses I really started to put on weight and also feel very sleepy. One option could've been to continue, but I could not really do my work as researcher under this dozy cloud, so I had to quit. Moreover, I felt I was less somewhat less "in touch with things" the experience was not _me_ being happier, but of some benign, but ultimately alien, happiness-inducing tumor settling in me&#8230;

Treatment period with mirtazapin: ~3,5months.

5) 
Bupropion (Zyban) was next. In my country, there is no Wellbutrin available and this meant no access to extended / sustained release bupropion. In other respects Zyban is pretty much the same as Wellbutrin. Well, it made me energetic which was positive, but also immensely irritable and even angry like nothing before. Occasionally when I got in an argument, I became furious and even broke stuff but fortunately (despite being a big guy 190cm/90kg) nobody got hurt anybody. This furor is something I've never experienced before or after. So, this was by far the worst experience and an obvious big nono for me.

Treatment period with bupropion: ~1month.

6) 
Then I tried an SNRI medicine called milnacipran (Ixel), 2x25mg => 2x50mg daily. Mild mirtazapin-like effect, but also some weird sexual side effects, like some anorgasmia and a loss of control of ejaculation&#8230; not nice. So this came to end very soon.

Treatment period with milnacipran: ~1 month.

After these experiences I have been pretty low since nothing seemed to help in my depression without causing other, severe issues.

7) 
Then my psychiatrist suggested a relatively new medication, a norepinephrine-dopamine disinhibitor called agomelatine (valdoxan), 1x25mg => 2x25 mg => 1x 25mg daily. This was a positive experience, even if its effectiveness was quite low. It improved the quality of my sleep and on some very diffuse level made me more open to positive ways of thinking about things. 2x25mg made me very tired, so I had to go back to 1x25mg, every night.

I started agomelatine ~3months ago and I am still using it at 1x25mg daily (just before going to sleep). However, the depression alleviation effect has felt quite diffuse, as I said. It is hard to tell exactly what it does. It just sometimes helps me to come up with a positive attitude or preconceptions towards a variety of things which previously felt just plain sordid. But in addition to being diffuse like this, the effect is also quite weak (compared to what I experienced with, say, cipralex). This is why I started to look for something that could agomelatine could be augmented with.

Actually, this was not when I first learned about tianeptine. I had found tianeptine long time ago and read some promising reviews in medical journals and wondered if this this could be my medicine. The problem is, tianeptine is not available in my country so I had to visit another country to get a prescription and buy the medicine.

(Side point: Visiting another country "to get a prescription" might have a nasty ring of some form of prescription tourism. However, I have always told my physicians about all my prescriptions, cannabis use and that I have seen other doctors for help. This is perhaps the only one thing that I can very strongly recommend without any reservations for anyone who is seeing a doctor with the serious intention of getting help. Because if this candidness causes a particular doctor to label you as "drug seeker" or "addict", or otherwise undermines your access to treatment, trust me, this particular doctor could not have helped you very much to begin with.).


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## teddy (Sep 4, 2010)

*B) My own experiences on the effects of agomelatine + tianeptine combination treatment*

So, anyway, during the past 11 days I have been on the following regimen:

agomelatine: 1x25mg daily
tianeptine: 3x 12,5mg daily
(cannabis: ~3 joints per week, see part A, if you are interested.)

First of all, this ago/tia is no miracle-making combination. I has not _cured_ me and with 99% certainly never will. And I don't think it is likely that any medication will.

This said, it has been by far the best medicine combination I have ever taken. Tianeptine makes me energized and keeps my mind running. Because of the sleepy-effect of agomelatine I still feel quite tired in the morning - but only during the first 5minutes! Then the feeling is gone and does not come back until in the evening when I take the agomelatine!

That is wonderful already in itself. I want to be awake when I am awake and when I want to sleep, I feel sleepy. I cannot emphasize enough the meaning of this for my ability to control my life and its importance in combating the kind of depression that feels most strongly in normal day-to-day interactions, as is the case with my depression!

Other than that I feel like tianeptine also gives me more energy to solve problems and will not allow me to be let down when something I try fails. Instead, I have found it easier to consider what I previously regarded as "failures" as sources of information pertinent to how not fail when I try again, and often even then go on trying again instantly. Granted, I occasionally feel a bit hypomanic due to this, but I think I might actually recognize "the old me" in this kind of behavior.

(Sidepoint: I find it very hard to remember how I really was like as a person before my depression in any concrete sense. I consider this odd, because I remember events that took place like 5 years ago very well. I wonder if that is typical to depression?)

So basically I feel like agomelatine makes me a small bit more rested by improving my sleep quality and vests me with a tendency of looking for good sides ("good" in the sense of being useful in my pursuit of happiness) in all kinds of phenomena. Tianeptine then gives me some energy to perform some of the actions I deem useful in this sense.

A concrete example of this dual effect would be: A person relates some anecdote to me, which is not particularly interesting in and of itself. Unlike previously, I still keep my ears open and my "radar up" for any little bit that might interest me, even a bit. When I do this, I notice that quite often there actually is something that I wanted to know within that person's anecdote that I did not know I wanted to know. :yes

And even though I have been quite shy since my late teens, more often than not I actually ask questions and make the conversation go into the kind of directions that I consider pertinent in this respect. In short, I manage to get good things out of things that I never considered good before. But the verb here is kind of a misnomer. I do not just "get" the good things out things. Instead, I constantly work with my mind to refine the many kinds of data that I receive in such everyday interactions. With the disposition & the inclination (agomelatine helping here?) and the energy & mental strength (tianeptine helping here?) to do this refining work with the things I constantly experience, I feel that life is not so somber, gloomy and sordid.

*C) Back to me, myself and I - Using this medication as a weapon to combat depression*

Now, I am afraid to let my hopes up. 11 days is a _very_ short time period. Of course I fear all this might be away soon, that this is just a phase, a placebo effect brought up by my desperate brain as some last-ditch-effort and when I think like this, I am not sure about how much point is there in living after all.

It is such a cliché, but it's so true for me: the horribility of fear itself for this thing (living with depression) is the great part of the reason why the thing is feared for in the first place. And when things are looked through this veil of that fear it appears as if it was just rational and logical to fear life and be depressed in this desperation and that the only people who are not afraid are just the idiots who do not realize how logical it is to be depressed. And in some sense I still think it is true: had others experienced the very same fear of utter lack of any meaning in life, I believe they would have seen its logical end-point in desperation, which is the root cause of depression.

But somehow this feels like a problem of a very different scope and proportions, something like meta-depression. For now, I still lack the weapons to combat this meaninglessness -> desperation -> depression cycle. I have tried to dodge the meaninglessness experiences triggering the cycle with some moderate success and, indeed, the agomelatine / tianeptine has made me more agile and nimble in this respect.

It's as if a great giant is trying to bludgeon me with a huge club, and few times I have moved away from under the shadow the club just seconds before it hits, and now with the medication either the giant has become slower or I have become faster or both. But I still live constantly under the club. But unlike in real life, where dodging the club becomes easier if you focus on the club, with depression the focus on the club seems to make the club follow you like a homing missile. It is only by looking away from the club that allows me to take the crucial and redeeming side-step.

So, I am now happier than I have been in quite some time. I still wish I did not have to live under the shadow of the club for the rest of my life. Then again, especially at this point, considering things such as "the rest of my life" is exactly what I know I should not be doing, because that is the equivalent of "focusing on the club" that paralyzes me and can eventually make the club hit. I guess dealing with this dilemma is what living with depression is all about.

&#8230;or then not. With this I mean that I have been considering on seeing a therapist, and with the recent extra strength I might just do that. Some of the first doctors I saw did not consider therapy useful in my case, but then again, at that point I did not know myself and my depression the way I do now and hence I was not able to relate them these things that I am now telling to you. I am not sure if I should dare to say this aloud, but I deep down I still do not accept the living my life avoiding looking at the club. I have read my Sartre and I know that there is no definite answer to the deep questions of meaning, but hope to find _an_ answer that would render me able to look in any direction, even towards the club, without the fear of being crushed.

*Any comments and questions are much appreciated. 
*
(P.S. Thanks go to euphoria, to whom I pm'd and who urged me to write about this.)


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## foxy (Jul 3, 2010)

*Not cool*

You have taken near on all class,s of meds, but most for no where near enough time to do any good.All my meds take 3 months to kick in when starting new, plus you bail out on side effects . We all have side effects thats the trade of off nuking depression. we get fat we carnt shag you name it you will get it.You carnt keep nukeing meds because of side effects most subside after a time anyway.You just keep starting meds then detoxing you must feel rough anyone would . if you get %70 releaf an side effects your doing cool.


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## euphoria (Jan 21, 2009)

foxy said:


> You have taken near on all class,s of meds, but most for no where near enough time to do any good.All my meds take 3 months to kick in when starting new, plus you bail out on side effects . We all have side effects thats the trade of off nuking depression. we get fat we carnt shag you name it you will get it.You carnt keep nukeing meds because of side effects most subside after a time anyway.You just keep starting meds then detoxing you must feel rough anyone would . if you get %70 releaf an side effects your doing cool.


He tried them for 5 months, 4 months, 3.5 months, 1 month, 1 month, 3 months, respestively. I'd say even on the 1 month trials, that's long enough to see if a med is going to help or not. The effects may not have maxed out by the 4 week mark, but you'd be able to get a good idea what they're like. And the others he all took for at least 3 months.


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## foxy (Jul 3, 2010)

euphoria said:


> He tried them for 5 months, 4 months, 3.5 months, 1 month, 1 month, 3 months, respestively. I'd say even on the 1 month trials, that's long enough to see if a med is going to help or not. The effects may not have maxed out by the 4 week mark, but you'd be able to get a good idea what they're like. And the others he all took for at least 3 months.


Yes but he aborted them through side effects, A thing you have to put up with or stay depressed, I have jiont pain through out my body through sertraline but its cool on depression, what am i suppose to do.If the side effects are worse than the depression ,fair enough but i have clinical depression an if some one said chop your leg off an it will go away forever pass me a saw


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## teddy (Sep 4, 2010)

Thanks for commenting, and I do see your point, foxy. But the scenario you draw is a bit flawed, I think, because the choice is not really between:

a) use this medication that gives some moderate help and very annoying side-effects
or
b) be depressed for good.

Had I been forced to make such a decision, I most likely would've just used the medicine (not bupropion though, because I don't want someone else to die) like you suggested.

However, my gf and the doctors were suggesting that I keep on searching, that there might actually be a relief for me without side effects of the kind I described that made me quite miserable (although, granted, not as miserable as depression). And I must say I am really happy for those suggestions because the medication that I am now on, agomelatine + tianeptine combo works better than any of the ones before. So, yeah, in the end I am still happy that I changed the medication, even though the process of changing medication constantly has been more taxing than I ever imagined. In this respect this would be something that I still recommend.

And yes, 1 month is not enough to see how good a medicine is. But I think it is long enough to see if it is *any* good, if you see what I mean? If you feel absolutely horrible, or absolutely nothing, then it is not likely that that experience going to radically change after another month or two. Or do you really feel differently about that?


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## foxy (Jul 3, 2010)

*teddy*

[email protected] Here is the link to the forum on ago i am a member. You are lucky to be given a chance with agomelatine, i live in england an you dont get many new meds till there generic , so not a chance on ago unless i buy it myself let alone a second med to combo..and yes i do think it can take 12 weeks of pain before any break through on a med. I said sertraline took 12 weeks before i got relieve an after it can happen over night,prozac was the same.But i had 3 good years on prozac until generic came out, an the doctors in england were forced to use them because they were cheaper . You got any brand the chemist had , some better than other,s so a crash is bound to happen. Ago is hit an miss you are lucky, its not the wonder med it was claimed it was with many aborting ago as the relief often need to be proped up with other meds even ssri,s meaning back to side effects.


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## Konky (Oct 10, 2010)

I find tieneptine takes away the nagging down feeling that results in not being bothered to to stuff you know you should be doing, such as getting out of bed, running around the block, speaking up in meetings or class. This all helps with getting along and can be a useful mechanical aid. It doesn't make me enjoy things more though really I don't think. In fact I enjoy thinks such as music, tv, company more when I am off it. Having said that its the only med I keep now and its quite easy to stop and start - no brain zaps like SSRIs when you quit and no noticeable mood changes. I use the tienaptine once in a while now - maybe once or twice a week (after taking 4 tabs a day for a couple of years) if I have something stressful to do in a short timescale - like give a presentation or do a seminar. The downside is I get a bit lazy afterwards and can sit and watch tv or surf the internet for days quite happily and do nothing constructive if I am not careful. BTW I tried all the others you mentioned teddy and all had plus points but I gave them up because of getting fed up with the side effects (cannabis 5 years or more (made me anxious, a bit paranoid and so more introverted after a while), SSRI 6 years (sexual side effects, lethargy, not very dynamic or determined), Aurorix 1 year (paranoid, crap memory, made me dumb).


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## teddy (Sep 4, 2010)

I've also now noticed the same effect with my 3x12,5mg regimen of tianeptine. Namely that I may just search google or wikipediate info for hours or just get easily carried away with some other random activity.

I do not think it is only tianeptine because I have had some minor OCD-like problems earlier, but I think it is more pronounced now. At least now I can really recognize myself from that part your description, konky.

By the way, I week ago I started pregabalin (lyrica) due to my docs suggestion. Haven't noticed anything yet. Been taking 25mg x 2 for one week and tomorrow rise it to 50mg x 2 and go slowly up one week at a time. She said that it might also help me to cut down on cannabis because she thinks that more lyrica and less thc might help me. I do not know what to think about that yet, but I want to be a good patient. If I dont trust in my doc, I do not know who to trust.


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## Konky (Oct 10, 2010)

teddy said:


> I've also now noticed the same effect with my 3x12,5mg regimen of tianeptine. Namely that I may just search google or wikipediate info for hours or just get easily carried away with some other random activity.
> 
> I do not think it is only tianeptine because I have had some minor OCD-like problems earlier, but I think it is more pronounced now. At least now I can really recognize myself from that part your description, konky.
> 
> By the way, I week ago I started pregabalin (lyrica) due to my docs suggestion. Haven't noticed anything yet. Been taking 25mg x 2 for one week and tomorrow rise it to 50mg x 2 and go slowly up one week at a time. She said that it might also help me to cut down on cannabis because she thinks that more lyrica and less thc might help me. I do not know what to think about that yet, but I want to be a good patient. If I dont trust in my doc, I do not know who to trust.


What I mean with tianeptine is that for about 4 hours after a dose I can be productive and do things I don't enjoy such as cleaning or shopping. After it wears off I get lazy and unfocused and cant be bothered to do much..although I seem to be quite content just watching tv or wasting time on the internet. Hence having to to keep up the pills. This continues for quite a few days after coming off tianeptine Ive found - hard to get motivated.

With the thc. For me it just made me anxious and paranoid on it and likely a bit anxious when not. I used to smoke quite a bit on my own because though I enjoyed it I would be too anxious to be in company. Thats why I stopped. Re the pragabalin, I don't know much about it sorry. I know everyone is different but your doc's advice about thc would be the right one in my case.


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## bben (Oct 24, 2009)

It looks like you never tried any GOOD maois, just the crappiest one made.


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## teddy (Sep 4, 2010)

bben said:


> It looks like you never tried any GOOD maois, just the crappiest one made.


Which ones would be the good ones and why?


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## teddy (Sep 4, 2010)

Please don't get me wrong. I didn't mean the post above confrontationally or anything. I am just keen to know more if you have some information.


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## bben (Oct 24, 2009)

moclobemide (Aurorix) is the baby of the MAOIS. It is reversible and it is only selective for MAO-A. This means that without MAO-B inhibition as well your brain chemicals wont be raised in symphony like they should.

The best MAOIS are the classical irreversible ones like Nardil, Parnate, Marplan ect.


Even these are dirty and side effect ridden though. However, if you are desperate they kick the ssri medications butt. Nardil is more for anxious depressives and Parnate more for lethargic depressives.


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## teddy (Sep 4, 2010)

Thanks, I read a few articles on them. This is useful information for me - I did not realize that MAOIs differ to that great a degree.

I am relatively happy with my current regimen at the moment, but this is certainly something to consider.


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## Bustah (Jul 24, 2013)

foxy said:


> [email protected] Here is the link to the forum
> 
> Hi there - you can get Agomelatine in the uk. It's just hard and you need to keep fighting until you come across a doctor who is not a coward to prescribe something they don't know. My psychiatrist wanted to put me on lithium - basically out of laziness. He refused Agomelatine, lied to me saying it was not available and told me lithium or nothing. My GP would've prescribe it either (even though it is approved for use as a secondary treatment where SSRIs have failed - I had the Surrey NHS approval document in my hand) and so I wrote an angry and desperate (you know the sort!) to the GP surgery. It was exhausting, took several weeks but eventually another GP from the same surgery called to tell me to pick up the prescription. It's been fantastic. It resets your body clock - and a huge part of depression can come from the hormonal imbalances of a screwed circadian rhythm.
> 
> I partnered it will modafinil - which fights day time drowsiness - and it worked a treat.


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## T800 (Jun 13, 2013)

@ teddy

Is it true that stablon kicks in really fast? How long did you take it til you felt something?

And what happens if you miss a dose? Do you directly feel depressed again? 3 doses per day is pretty annoying. I wish they had a time released version.

And what about side effects? I heard that Stablon is now a controlled substance in France! This sounds pretty concerning if they are making such a fuss about it. Do you know anything about this?


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