Valdoxan (agomelatine) is unique and highly effective treatment for depression, anxiety, and similar ailments. Classified as an atypical antidepressant, Valdoxan, like most other antidepressants, increases levels of the neurotransmitters noradrenaline and dopamine. What makes this medication unique---and so effective---is its mimicking of melatonin.

Melatonin is responsible for the body's circadian rhythms, which include sleep/wake cycles, mood, anxiety, appetite, and body temperature, among other, lesser effects. Individuals with depression, anxiety, and similar disorders often have wildly disrupted circadian rhythms. Valdoxan helps get these back to normal, which, in the majority of patients, proves tremendously helpful.

Other benefits of Valdoxan versus other antidepressants include:

• Works faster than other antidepressants, with improvements seen within the first week.
• More effective in nearly all cases, with greater improvement and fewer relapses.
• Better tolerated, with no sexual side effects or weight gain.
• Easy to administer; a single dose at bedtime.
• No withdrawal symptoms when treatment ends, even abruptly.
• Non-addictive.

In addition to its use in treating depression and anxiety, Valdoxan can be used to help otherwise healthy patients restore regular sleep cycles.

Taking Valdoxan

Valdoxan comes in tablets of 25 mg. In the relatively rare instances when 25 mg is not sufficient, patients will be instructed to take two 25 mg tablets, for a total dose of 50 mg.

Tablets are taken once per day, ideally at bedtime. Food is optional.

Before treatment begins patients should have their liver function tested; this should be followed up with additional liver tests when dosage is modified and 3, 6, 12 and 24 weeks after starting treatment or following dosage adjustments.

Treatment is typically:

• Take one dose at bedtime every day.
• If a dose is forgotten, it should be skipped entirely. Resume treatment with the next dose at bedtime.
• Treatment should continue for at least 6 months after symptoms are resolved.
• Standard treatment is 9 months.
• Treatment can end abruptly; there are no withdrawal effects.

Most patients notice some improvement within a week of starting treatment, but it may take two weeks to a month for significant benefit to be seen. Provided no adverse effects develop, continue taking Valdoxan for at least a month even if no benefit is apparent. If no improvement is seen after a month, alternative treatments should be considered.

While Valdoxan does not generally induce drowsiness during wake cycles, some individuals may have residual sleepiness or mild dizziness, particularly at the start of treatment. Use caution when driving or performing other dangerous tasks until effects are known.

If needed, treatment can be repeated in the future if depression and/or anxiety return.

Availability in the USA

Though available in the UK, the EU, Australia, and numerous other locations for years, Valdoxan has not been approved in the US. US patients will need to acquire this medication through online sources or by visiting a country in which it's legal.

There are two reasons that Valdoxan is not approved by the US's FDA:

• Interacts with medications that influence CYP1A2 levels;
• Has the potential to cause liver damage.

CYP1A2 is an enzyme used in metabolism. Many medications can influence CYP1A2 levels, as well as many other things---smoking, eating grilled meat or cruciferous vegetables, consuming caffeine, and so forth. While taking Valdoxan along with a medication that alters CYP1A2 levels or relies on CYP1A2 for metabolism may cause problems, it is very unlikely to be problematic for those not taking such medications.

Liver damage is more complex. Nearly every medication available has the potential to cause liver damage, and most should not be used when severe liver damage is present. Valdoxan, too, should be avoided when liver damage is present, but in patients with a well-functioning liver this topic is a little controversial. There is no evidence of liver damage in short-term use (up to 9 months), but risk of liver damage may increase with longer-term use.

Basically, patients taking medications that influence or rely on CYP1A2 should not take Valdoxan. Likewise patients with moderate to severe liver damage should probably not take Valdoxan. For other patients, provided regular doctor checkups are attended so such things can be monitored, there is unlikely to be any serious consequences, particularly if the medication is taken for 9 months or less.