It’s no secret that I’m a strong believer in medicine and pharmacology, and I can list a few life-changing medicine just from my own mid-length (32-years) life. But how Valdoxan changed my life in the past few weeks is a big story for me because it probably is the most radical and noticeable change in my life, and one that I had no hope of seeing happen.
I have delayed sleep phase disorder: I normally go to sleep around 06:00 and wake up around 14:30. Although I can wake up early with alarm clocks when necessary, this doesn’t mean that I can go to sleep earlier that day; getting little sleep doesn’t change the fact that I cannot sleep before 06:00. So this is not something I can change altogether; this is the way my body wants to live. That’s why some people say that this isn’t really a disorder or an illness; it is simply our natural rhythm. (On the other hand, DSPD is classified as a disability; schools and employers in the U.S. are required, under the Americans with Disabilities Act, to provide reasonable accommodations, including part-time or modified work schedules.)
I hate everything about sleeping. All my life I hated waiting for sleep to come, when the time I “have to” go to sleep comes. (For the last decade it’s been 06:00, to keep at least some contact with the society between 15:00–17:00 the next day.) I hate the tortuous period between when sleep reluctantly reveals itself and when I fall asleep, lasting from 30 minutes to 300 minutes, where I try to play by its rules and dance with it so that it can finally take me. I hate the fact that there is a proper time to sleep in people’s eyes, and they expect you to be asleep and to be awake according to that schedule. I hate it when they propose correction methods when they discover you don’t sleep when they do – partly because they’re expecting me to fit in, but mostly because those famous methods don’t work for me.
Even if I can drug myself to sleep with some (believe me, I’ve tried many) sleep-inducing medicine like Remeron at a normal hour, and force myself to wake up early the next day, my brain just doesn’t play along: it refuses to function properly until its real wake-up times come, causing me to suffer zombie-mode until 17:00 where it suddenly switches on. It’s all great when I live in the right hours, between 14:30 and 06:00.
I don’t know whether it’s related to the tumor or not, but it’s definitely not an anarchistic lifestyle choice; it’s something biological, which puts you in a position to create a compatible lifestyle. Sometimes it’s a blessing, other times it’s a curse. (Like when there’s a construction in your building for two months and you wake up with drilling sounds at 10:30 every day with a few hours of sleep and there’s nothing you can do to sleep early and get enough sleep and your life becomes hell and…) But I had accepted it. I had managed to build a life around it, with a home-office self-employed working mode (this choice is not solely related to my circadian rhythm) and lovely clients who accept that the earliest meeting time with me is 16:00. Everything was under control.
In January I restarted Valdoxan (agomelatine, an antidepressant), as a possible treatment for the mysterious abdominal pain attacks I’d been having, and the strangest thing happened: I started to get sleepy a little earlier every day, and to wake up earlier in the same progression. It wasn’t the classic antidepressant sleepiness/drowsiness side effect; I was perfectly fine during the day. (Valdoxan is famous for not having such side effects.) What’s more, I wasn’t getting sleepy after I take the pill. On my psychiatrist’s orders, I was taking it just before I go to sleep, so the sleep was coming first, not the pill. This was a long-term, general effect: my circadian rhythm was slowly shifting.
I had never experienced such a thing before. Waking up at 13:00 for a few days in a row was a huge difference for me, but it didn’t stop there. When it hit 11:00 it was so unbelievable to me and to people around me that we started joking: “Next week I’ll be waking up at 9 am, before you do, and I’ll be doing morning jogging…” I’m still not doing jogging but I really did wake up at 09:00 today. Normally 02:00 was the beginning of my evening where I was filled with energy to do things, but now I can hardly stay awake to see it. And it doesn’t feel forced or artificial: reminiscent of my early childhood, I can feel the night slowly taking effect, and a very natural and healthy sleep taking over me. I became normal.
On the one hand, this is an expected result: Valdoxan is known to have such resynchronizing effects.
Agomelatine produces strong effects on circadian sleep phase disturbances, improving time to sleep onset and quality of sleep.
A resynchronizing activity of agomelatine was seen in animal models for delayed sleep phase syndrome and in several original models of circadian disturbance, such as rodents infected by trypanosome or old hamsters. This activity of agomelatine on circadian rhythms was further confirmed in humans.
On the other hand, this was my second experience with Valdoxan; I had used it between June 2014 and May 2016 (for other reasons) and my sleep hours hadn’t changed. I found a plausible answer to this puzzle when I remembered what my pharmacologist friend had said when she’d learnt that I’d started Valdoxan back in 2014: My antiepileptic medicine Tegretol (carbamazepine), as a strong CYP1A2 inducer, would increase the metabolism of Agomelatine, a CYP1A2 substrate, and significantly decrease its effects.
In 2014 I was using 800 mg of Tegretol. In December 2016 I started to decrease the dosage of Tegretol. I restarted Valdoxan in January 2017, with 600 mg of Tegretol in the background, and this time Valdoxan was able to do its work. This all makes sense when I consider that 750 mg is some kind of a threshold for me for Tegretol, both for its neurological effects and blood levels.
Living with a normal circadian rhythm is a totally unknown territory for me – one that I’m exploring cautiously. At first I was not sure it was going to last, and was reluctant to accept it as a lifestyle change. But as time passed I started to make arrangements to adapt to this new mode of living. I’m still in the process of getting used to it, and I’m sharing it with more and more people who know me. (I’ll use this post for many of them. Hello.)
Aside from the obvious advantages of having more time with my girlfriend or seeing more sunshine, my favorite difference between my old and new lifestyles is this: normally I check my inbox around 15:00 after I wake up, to find many emails from clients about the ongoing projects. I try to put them in a priority order and deal with the urgent ones before the business day ends (in 2–3 hours). This means that every day I wake up with the urgent question “What do I need to do now? Who needs me?”, face many surprises within seconds, and start working – an obvious source of anxiety. Now, I wake up to find 0–1 work-related email in my inbox. (In the first days it was confusing: “Now what do I do? Go back to sleep?”) I have time to properly wake up, have a nice breakfast, read, etc. before the emails arrive, one by one, during the day. And I increasingly appreciate how great this is and how much less anxiety I experience overall. (Another nice surprise is the 20% reduction of my electric bill.)
I don’t know how long this will last. For one thing, I may have to up the dosage of Tegretol again if neurological problems re-emerge. That will probably decrease Valdoxan’s effects like it did in previous times. Another question is this: Will I go back to my old circadian rhythm if I quit Valdoxan? After 1 year of use? After 3 years? Or will the effects decrease even if I keep taking it? But for now, I don’t want to dwell too much on these questions. I just want to enjoy my new lifestyle for as long as I can. For example, right now it’s midnight and I’m already sleepy. And you probably don’t understand how strange this is.