There is a new antidepressant available:
Agomelatine, which has a novel mode of action as it works on melatonin receptors as well as certain serotonin receptors. It was initially researched as a treatment for jet lag because of the association between melatonin and sleep.
However, it was found to also benefit mood. It has what’s called a ‘hit and run’ action, very short-lived, so there are few side effects and low risk of addiction. A single night-time dose of 25mg often effects some improvement in the first 2 weeks , unlike most antidepressants that can take 3-4 weeks to start working.
Essentially it resets the circadian rhythms which are often out of sync in depression, causing frequent waking during the night and often early morning wakening. There is no known discontinuation syndrome such as we see with other antidepressants and sedatives.
I am not aware of it being trialled in people with chronic pain but it could be worth trying, especially for disturbed sleep and low mood. It is licensed for use in major depressive episodes, which means there are a number of features such as loss of interest in things, either apathy or agitation and feeling low in mood, plus changes in sleep and appetite, these symptoms having lasted for more than 2 consecutive weeks.
Disclosure: I have no association with Servier, manufacturers of Valdoxan.
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