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Posted (edited)

MODERATOR NOTE: Click here to read tips on how to make a liquid 


 

As I am taking a medication not many people have experience with, there is no topic about tapering it. I am not at a stage to start tapering Valdoxan, but I constantly worry, that once I wish to start, there is no information or support available for me to take guidance from.

 

So I started this topic here and I am asking if anyone has any piece of information on how one would go about tapering Valdoxan, please be so kind and post here. Or if you know of anybody who has already done it or if you have stumbled upon any information anywhere else in the Web. Perhaps by the time I am ready to taper these pieces of information will have formed a good plan.

 

Background:

  • The Valdoxan pill has a coating so I am worried what will happen, if I break it. It has no line for breaking either. 
  • Also I have no idea if it would be ok to make it into a liquid. I would like to do a liquid taper, if possible, because I see no other way to do it accurately.
  • It is said to have an effect on the melatonin system and the pharmaceutical company claims it has no WD. I know better not to believe that but could it still be a bit of a good sign that they have not had acute WD problems in their short term studies? Or am I too naive to hope that?

 

Edited by Altostrata
added mod note
  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

Posted

Also, does anyone have any information (I could not find) what the polymer coating on Valdoxan pills is used for. I know the coating can serve many purpouses (easier to swallow, protect from acidity in the stomach, be recognizable etc).

 

"Most enteric coatings work by presenting a surface that is stable at the highly acidic pH found in the stomach, but breaks down rapidly at a less acidic (relatively more basic) pH. For example, they will not dissolve in the gastric acids of the stomach (pH ~3), but they will in the alkaline (pH 7-9) environment present in the small intestine."

 

Could it be Valdoxan also has a coating that is supposed to make it dissolve in small intestine?! How to taper then?

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

Posted

Is 25mg the lowest available dose?  Perhaps the manufacturer makes smaller pills?

 

I honestly don't know if the low pH of the stomach will alter the chemical structure of the drug - the aldehyde in the chemical structure may become reduced in the stomach, but then oxidized in the small intestine, making no difference at all. 

 

Here's my hunch:  I would assume that there's no problem with taking the coating off - because these classes of drugs all tend to look relatively similar, and yet there are a number of them that are very likely exposed to the low pH of the stomach during digestion that still retain their effectiveness (e.g., any of the drugs that don't have a seal or a cap).   A drug like prozac has a cap, and then direct powder - no beads, and there are other drugs like this as well.  Instead, the cap may be to extend the release of the drug into the bloodstream, rather than protect it from the low pH of the stomach - in which case it's not going to alter the drugs effectiveness.

 

If you look at the chemical structures of a drug like prozac, and Valdoxan, you will see the same general arrangement:  a couple aromatic rings (the six sided carbon rings with double bonds), and then some side chains of carbons with functional groups (the Oxygen molecules, and nitrogen molecules are parts of functional groups). 

 

Here's the structures of some common drugs for comparison:

 

https://en.wikipedia.org/wiki/Fluoxetine

 

https://en.wikipedia.org/wiki/Agomelatine

 

https://en.wikipedia.org/wiki/Duloxetine

  • Administrator
Posted

osk, please do not speculate about the coating on these tablets when, with a little effort, you can find the factual answer, which would be of great help. On the other hand, speculative answers may confuse and mislead people.
 
For example, http://www.medicines.ie/medicine/14490/SPC/Valdoxan+25mg+Film-coated+Tablets/gives information from the manufacturer, Servier.
 
 

6.1 List of excipient(s)

Tablet core:
− Lactose monohydrate
− Maize starch
− Povidone K 30
− Sodium starch glycolate type A
− Stearic acid
− Magnesium stearate
− Silica, colloidal anhydrous
Film-coating:
− Hypromellose
− Yellow iron oxide (E172)
− Glycerol
− Macrogol 6000
− Magnesium stearate
− Titanium dioxide (E171)
Printing ink containing shellac, propylene glycol and indigotine (E132) aluminium lake.

 

 

There is no indication the coating is a time-release coating. It is just an ordinary coating. The tablet could be split.

 

I would be skeptical of the claims from short-term clinical trials that there is no difficulty in withdrawing from agomelatine. See this discussion http://survivingantidepressants.org/index.php?/topic/965-agomelatine-melatonin-as-an-ad/

 

Use of search on this site or on the Web can answer many questions.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Posted

Is 25mg the lowest available dose?  Perhaps the manufacturer makes smaller pills?

 

Yes, it is the smallest available.

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

Posted

 

 

There is no indication the coating is a time-release coating. It is just an ordinary coating. The tablet could be split.

I also found the ingredients' list of the coating but I did not know what to make of it. I am not that knowledgeable in chemistry to know if that makes it an extended release one or not. I also found no reference to it being extended release but then I thought that you'll never know. Perhaps someone in the industry just didn't think a "commoner" like me needed to know their pill had this or that quality (for example where it was meant to be absorbed).  

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

Posted

Hi Erer, I think you might be the first person to join with Valdoxan as the problem. Congratulations for getting off Cymbalta, Xanax, and Ativan, and the others.

 

I am interested in Valdoxan because it is not available in the US and it so different from other antidepressants, and have read many users' descriptions of side effects. Not much is said about getting off the drug. (I just realized that.) Maybe because it's usually painless, or maybe because so many people only take it for a few weeks before quitting.

 

The two quitters I found are on the same web page. They are faste99 and petg57. They both report difficulty but do not describe symptoms. That's only two people, though.

http://www.drugs.com/answers/hi-friends-hope-all-is-well-with-you-all-435468.html

I wouldn't have known what all those chemicals in the coating meant, either  :o 


 

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

  • 7 months later...
Posted

have you found out if valdoxan dissolves in water and can be made to liquid? I have people who ask for advice from me, and I can't answer this particular case about valdoxan. as I understand, it can be cut, but what about liquid?

in 2002- 0,5 tablet cipramil for half a year, ended it uneventfully. in 2006 - citalopram for half a year, ended in horrific state, ditched the drugs CT. 2007-2008 not feeling well but drug free. in 2008 prozac 20mg + quetiapine 25mg. 2009 tried to stop, ended up in hole after couple of months, started zoloft. 2009-2011 zoloft 50mg. went to 25mg in 2011 summer, it resulted in half a year horrible suffering. reinstated, changed drugs, nothing happened. by 2012 beginning suddenly felt great and CT meds. after 4 months came suddenly most horrible human suffering that's possible. was started on prozac and questiapine. started tapering slowly, GFCF diet and Hardy Nutritionals vitamins in 2013 summer. 

current medications: 1) fluoxetine and quetiapine since Aug 2012; 2) Daily Essential Nutrients by Hardy Nutritionals 7 capsules / since May 2013 + omega3; 3) Gluten-free-casein-free diet since june 2013

Started withdrawing slowly since april 2013. Mostly around 10% cuts. 

April'13 - March'14: fluoxetine 40mg -> 19,5mg; quetiapine 50mg -> 40mg
April'14-March'15: fluoxetine 19,5mg -> 14,4mg; quetiapine 40mg -> 22mg

April'15-March'16: fluoxetine 14,4mg -> 7,4mg; quetiapine 22mg -> 15mg

April'16-March'17: fluoxetine 7,4mg -> 5,0mg; quetiapine 15mg -> 7,25mg

April'17-March'18: fluoxetine 5,0mg -> 4,0mg; quetiapine 7,25mg -> 0 (as of 1st Feb 2018)!!!!

April´18-March´19: fluoxetine 4,0mg - > 2,3mg. Jumped off fluoxetine 1,4mg due to pregnancy in July 2019. Oct 2019 severe withdrawal syndrome started.

Took mistakenly a complex for hormonal support that included pregnenolone dec2019-april2020. Stopped it april 2020 and immediately severe akathisia started. Have had life threatening akathisia since, 100% disabled, suicidal, very hard to hold on. 

 

  • Administrator
Posted

Most drugs can be made into a liquid. There are compounding recipes for this. Please ask a pharmacist and let us know what you find out.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Posted

there are no compounding pharmacies in Estonia. 

in 2002- 0,5 tablet cipramil for half a year, ended it uneventfully. in 2006 - citalopram for half a year, ended in horrific state, ditched the drugs CT. 2007-2008 not feeling well but drug free. in 2008 prozac 20mg + quetiapine 25mg. 2009 tried to stop, ended up in hole after couple of months, started zoloft. 2009-2011 zoloft 50mg. went to 25mg in 2011 summer, it resulted in half a year horrible suffering. reinstated, changed drugs, nothing happened. by 2012 beginning suddenly felt great and CT meds. after 4 months came suddenly most horrible human suffering that's possible. was started on prozac and questiapine. started tapering slowly, GFCF diet and Hardy Nutritionals vitamins in 2013 summer. 

current medications: 1) fluoxetine and quetiapine since Aug 2012; 2) Daily Essential Nutrients by Hardy Nutritionals 7 capsules / since May 2013 + omega3; 3) Gluten-free-casein-free diet since june 2013

Started withdrawing slowly since april 2013. Mostly around 10% cuts. 

April'13 - March'14: fluoxetine 40mg -> 19,5mg; quetiapine 50mg -> 40mg
April'14-March'15: fluoxetine 19,5mg -> 14,4mg; quetiapine 40mg -> 22mg

April'15-March'16: fluoxetine 14,4mg -> 7,4mg; quetiapine 22mg -> 15mg

April'16-March'17: fluoxetine 7,4mg -> 5,0mg; quetiapine 15mg -> 7,25mg

April'17-March'18: fluoxetine 5,0mg -> 4,0mg; quetiapine 7,25mg -> 0 (as of 1st Feb 2018)!!!!

April´18-March´19: fluoxetine 4,0mg - > 2,3mg. Jumped off fluoxetine 1,4mg due to pregnancy in July 2019. Oct 2019 severe withdrawal syndrome started.

Took mistakenly a complex for hormonal support that included pregnenolone dec2019-april2020. Stopped it april 2020 and immediately severe akathisia started. Have had life threatening akathisia since, 100% disabled, suicidal, very hard to hold on. 

 

  • Administrator
Posted

http://www.caymaneurope.com/pdfs/13203.pdfProduct information

Agomelatine is soluble in organic solvents such as ethanol, DMSO, and dimethyl formamide. The solubility of agomelatine in these solvents is approximately 30 mg/ml.
 
Agomelatine is sparingly soluble in aqueous buffers. For maximum solubility in aqueous buffers, agomelatine should first be dissolved in ethanol and then diluted with the aqueous buffer of choice. Agomelatine has a solubility of approximately 0.5 mg/ml in a 1:1 solution of ethanol:PBS (pH 7.2) using this method. We do not recommend storing the aqueous solution for more than one day.

 
This means agomelantine is soluble in drinking alcohol, such as vodka or other clear spirits. Taking a milliliter or two of vodka mixed with agomelantine probably would not cause problems.
 
DMSO is non-alcoholic but tastes terrible; if you use DMSO as a solvent, be sure to get medical-grade DMSO liquid that is safe for ingestion.
 
You can crush a tablet and mix the powder with water (aqueous buffer) to make a suspension. There will be little particles floating around. You will need to do this every day. Also see
 
How to make a liquid from tablets or capsules
 
Using a digital scale to measure doses
 
Compounding pharmacies (US, UK, and elsewhere)

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

  • 3 months later...
Posted

Just wondering if anybody has any new information regarding Valdoxan or experiences tapering it.

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

  • 1 month later...
Posted

Bump. I'm also tapering Valdoxan and am wondering if it may be causing the akathisia I'm experiencing.

History:

Escitalopram 10mg Nov - Jan 2016 (switched to Effexor XR)

Effexor XR 37,5mg Jan - Feb 2016; 75mg Feb - April 2016; 37,5mg for one week in April, 75mg April-July 2016 (started tapering, took my last beads on Sept 11.)

The fluctuations happened because my GP mistakingly prescribed me the wrong dosage.

Oxazepam 2x10mg Dec 2015 - Jan 2016 (basically CT but no apparent symptoms); June 2016 - Feb 2017 (c/o to Valium)

 

Current:

Valdoxan 25mg Dec 2015 - Sept 2016. 12.4mg (Sept - Nov '16) -> 11.86mg (Nov '16) -> 10.75mg (Dec '16) -> 9.75mg (Jan '17) -> 8mg (March '17) -> 7mg (April '17) -> 4.5mg (May '17) -> 4mg (Jan '18) -> updosed to 4.5mg in the end of January

Valium (liquid form) 8.5mg Feb 2017. 7.6mg (June '17) -> 7.2mg (June '17) -> 6.8mg (July '17) -> 6.4 (Sept '17) -> 6.2 (March '18) -> 6 (April 7 '18) -> 5.8 (April 17 '18) -> 5.6 (April 26 '18) -> 5.4 (July 16 '18) -> 5.2 (March '20) -> 5 (March '20)

What to take away from all this: if you feel extremely sick only after a few doses of an AD, please tell your doctor and just stop. Adding medications is no bueno.

 

  • 4 months later...
Posted

I switched from Cymbalta to Valdoxan on my GP's advice.  I told him what I had learned from this site about tapering and buying empty capsules to make up smaller and smaller doses.  He agreed that it made sense.  By that stage I think I had already reduced to about 75% of my prescribed dose.  He put me straight on Valdoxan, and told me to continue to taper off the Cymbalta.  I had no cymbalta withdrawals and the Valdoxan was noticeably better. On Valdoxan my sex life and orgasms returned to normal and I generally felt better.  It's more subtle than Cymbalta.  It allowed me to feel whereas Cymbalta was flattening and deadening.

 

I am now looking to go off Valdoxan after a year on it.  The main reasons are expense, liver health and readiness.  It is expensive.  In Australia it is not on our pharmaceutical benefit scheme so it costs a lot more than other ADs.  My liver function tests (you must have 3 in the first 6 months) were fine but I drink a bit and it's better to not combine alcohol with Valdoxan.  And also I am ready.  I have been getting good help from a psychologist and know what I must physically actually do with my life and habits to improve my depression.  

 

My GP suggested waiting a little longer; he said another year.  I've been on it for about a year.  But I think I am ready.  He said that Valdoxan is unusual amongst ADs in that there are no withdrawal symptoms other than the potential for relapse.  I found this at medicines.org: 

 

Withdrawal / Discontinuation

The abrupt discontinuation of VALDOXAN (agomelatine) was evaluated in a specific active control study (CL3-030) using the Discontinuation Emergent Signs and Symptoms (DESS) check-list. Patients with major depression were treated under double-blind conditions with VALDOXAN (agomelatine) 25 mg or paroxetine 20 mg over a 12 week period. Only those who remitted at week eight and sustained that remission until week 12 were randomised to placebo or the initial active treatment for a two-week double-blind period. Patients discontinued from VALDOXAN (agomelatine) to placebo were compared to those who continued treatment on VALDOXAN (agomelatine) and, likewise for the active control paroxetine.

The abrupt discontinuation of VALDOXAN (agomelatine) was not associated with discontinuation symptoms [p=0.250 for difference between the VALDOXAN (agomelatine) and placebo groups]. The sensitivity of the study was demonstrated by the presence of significant emergent discontinuation symptoms following the abrupt discontinuation of treatment with the active control paroxetine [p<0.001 for difference between the paroxetine and placebo groups]. 

 

I'm sure this has come from the manufacturer, but nevertheless it describes double blind testing where there were no discontinuation symptoms.  Like others here, I have found it hard to find anything about Valdoxan withdrawal symptoms.  So maybe people are not having the same problems with Valdoxan as with other drugs?

 

I am going to stop taking Valdoxan, without tapering, in association with meditation and exercise.  I will try to remember to report back here.  

A closed mouth gathers no feet

  • Administrator
Posted

The 12-week period on Valdoxan used in this study to evaluate the risk of Valdoxan withdrawal is shamefully inadequate. A year is truly long-term exposure.
 
A comparison of 12 weeks of Valdoxan with (presumably) 12 weeks of paroxetine (Paxil), which has a vicious withdrawal syndrome, is not only dishonest but cruel to the experimental subjects who were put on paroxetine and then ripped off it.
 
Googling around, I see there are reports of Valdoxan withdrawal syndrome, even though Valdoxan is very infrequently prescribed, probably because it has a reputation for being expensive but not particularly effective, see https://www.thelocal.fr/20170127/french-told-to-avoid-82-drugs-that-do-more-harm-than-good
 
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0061425/
 

Agomelatine versus other antidepressant medication for depression
This version published: 2014; Review content assessed as up-to-date: July 01, 2013.
.... 
The reviewers conclude that agomelatine is not more effective than other antidepressants currently on the market. It did seem to be more tolerable to patients in terms of lower rates of some side‐effects, however, the quality of trials was low and there were only a few trials that compared agomelatine with each medication. No firm conclusion on agomelatine can be made because of problems with reporting of data in the trials included. The authors recommend that further trials of agomelatine versus placebo (dummy pill), particularly in primary care settings (where the majority of patient/practitioner contact take place, e.g. GP surgeries), should be carried out to improve the quality of evidence.

 

I'm sure Valdoxan is being marketed as having minimal withdrawal problems -- exactly like all the other newer antidepressants, including paroxetine.
 
If you want to go off Valdoxan, if I were you, I'd try a 10% reduction and see what happens. Please let us know how you do.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Posted

In my googling, I could not find any reports of Valdoxan withdrawal syndrome.  If you can point to any, altostrata , I would be very grateful.

 

Not too worried about the poor subjects pulled off Paroxetine in this test; more interested in the lack of discontinuation symptoms suffered by those pulled off Valdoxan.  I spoke to my GP at length about this.  Although he wants me to stay on for longer, he said that when i stop, I should just stop and not taper as with the Cymbalta.

 

I've always been one for testing the orthodoxy.  So I'm going to just drop off Valdoxan, keep a small stash in case it goes to crap, and see what happens.  Will report back.  

A closed mouth gathers no feet

  • 3 weeks later...
Posted

How are you doing? Did you experience any insomnia or other problems? I'm tapering Valdoxan too and made a big jump a few days ago. Can't sleep properly and had stomach cramps for the first few days.

History:

Escitalopram 10mg Nov - Jan 2016 (switched to Effexor XR)

Effexor XR 37,5mg Jan - Feb 2016; 75mg Feb - April 2016; 37,5mg for one week in April, 75mg April-July 2016 (started tapering, took my last beads on Sept 11.)

The fluctuations happened because my GP mistakingly prescribed me the wrong dosage.

Oxazepam 2x10mg Dec 2015 - Jan 2016 (basically CT but no apparent symptoms); June 2016 - Feb 2017 (c/o to Valium)

 

Current:

Valdoxan 25mg Dec 2015 - Sept 2016. 12.4mg (Sept - Nov '16) -> 11.86mg (Nov '16) -> 10.75mg (Dec '16) -> 9.75mg (Jan '17) -> 8mg (March '17) -> 7mg (April '17) -> 4.5mg (May '17) -> 4mg (Jan '18) -> updosed to 4.5mg in the end of January

Valium (liquid form) 8.5mg Feb 2017. 7.6mg (June '17) -> 7.2mg (June '17) -> 6.8mg (July '17) -> 6.4 (Sept '17) -> 6.2 (March '18) -> 6 (April 7 '18) -> 5.8 (April 17 '18) -> 5.6 (April 26 '18) -> 5.4 (July 16 '18) -> 5.2 (March '20) -> 5 (March '20)

What to take away from all this: if you feel extremely sick only after a few doses of an AD, please tell your doctor and just stop. Adding medications is no bueno.

 

Posted

It's strange but two of my posts have been removed.  In those I described that I had no discontinuation symptoms other than obviously noticing a difference in my general mood.  I still have no symptoms and am feeling well.  A few days ago, I spoke to a close friend who is a psychiatrist and she said to keep watching, especially after a few months, and be aware that things can happen after a few months.  She also agreed that Valdoxan is said to be free of withdrawal symptoms. But so far I'm fine after about 3 weeks.  

 

Perhaps a moderator might answer this question about why my posts were taken down?

A closed mouth gathers no feet

Posted

Glad to hear that you're doing good! I hope my symptoms subside, too. If not, I'll probably have to go back up again to 5 or 6 mg.

History:

Escitalopram 10mg Nov - Jan 2016 (switched to Effexor XR)

Effexor XR 37,5mg Jan - Feb 2016; 75mg Feb - April 2016; 37,5mg for one week in April, 75mg April-July 2016 (started tapering, took my last beads on Sept 11.)

The fluctuations happened because my GP mistakingly prescribed me the wrong dosage.

Oxazepam 2x10mg Dec 2015 - Jan 2016 (basically CT but no apparent symptoms); June 2016 - Feb 2017 (c/o to Valium)

 

Current:

Valdoxan 25mg Dec 2015 - Sept 2016. 12.4mg (Sept - Nov '16) -> 11.86mg (Nov '16) -> 10.75mg (Dec '16) -> 9.75mg (Jan '17) -> 8mg (March '17) -> 7mg (April '17) -> 4.5mg (May '17) -> 4mg (Jan '18) -> updosed to 4.5mg in the end of January

Valium (liquid form) 8.5mg Feb 2017. 7.6mg (June '17) -> 7.2mg (June '17) -> 6.8mg (July '17) -> 6.4 (Sept '17) -> 6.2 (March '18) -> 6 (April 7 '18) -> 5.8 (April 17 '18) -> 5.6 (April 26 '18) -> 5.4 (July 16 '18) -> 5.2 (March '20) -> 5 (March '20)

What to take away from all this: if you feel extremely sick only after a few doses of an AD, please tell your doctor and just stop. Adding medications is no bueno.

 

  • 1 month later...
  • Moderator Emeritus
Posted (edited)

Hi Marx, I am going to move your post to start an introduction for you. All members must have an introduction with a signature to enable them to reply to other topics. 

I will reply to your valdoxen withdrawal over there. 

 

Here is your new topic Marx 

 

Edited by mammaP

**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

 

Different drugs occasionally (mostly benzos) 1976 - 1981 (no problem)

1993 - 2002 in and out of hospital. every type of drug + ECT. Staring with seroxat

2002  effexor. 

Tapered  March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

Tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg  

 July 2017 30mg.  May 15 2018 25mg

Taking fish oil, magnesium, B12, folic acid, bilberry eyebright for eye pressure. 

 

My story http://survivingantidepressants.org/index.php?/topic/4199-hello-mammap-checking-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

 

  • Moderator Emeritus
Posted
On 2017-5-15 at 11:33 AM, RipVanWinkle said:

It's strange but two of my posts have been removed.  In those I described that I had no discontinuation symptoms other than obviously noticing a difference in my general mood.  I still have no symptoms and am feeling well.  A few days ago, I spoke to a close friend who is a psychiatrist and she said to keep watching, especially after a few months, and be aware that things can happen after a few months.  She also agreed that Valdoxan is said to be free of withdrawal symptoms. But so far I'm fine after about 3 weeks.  

 

Perhaps a moderator might answer this question about why my posts were taken down?

Sometimes we move posts to a members introduction topic. You might find the missing posts there. When a post is specifically about a member's situation it is best ion their introduction for continuity. We can't delete posts, we can hide inappropriate ones but they are still on the site. I am sorry this has confused you. 

**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

 

Different drugs occasionally (mostly benzos) 1976 - 1981 (no problem)

1993 - 2002 in and out of hospital. every type of drug + ECT. Staring with seroxat

2002  effexor. 

Tapered  March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

Tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg  

 July 2017 30mg.  May 15 2018 25mg

Taking fish oil, magnesium, B12, folic acid, bilberry eyebright for eye pressure. 

 

My story http://survivingantidepressants.org/index.php?/topic/4199-hello-mammap-checking-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

 

  • 1 month later...
Posted

Anyone?..

 

On 26/06/2016 at 1:43 PM, rapunzel2 said:

have you found out if valdoxan dissolves in water and can be made to liquid? I have people who ask for advice from me, and I can't answer this particular case about valdoxan. as I understand, it can be cut, but what about liquid?

 

2016 ~may-june: 25mg valdoxan

2017 ~may: stopped cold turkey

currently going through withdrawal (blurry vision, sensitivity to light, bouts of nausea, headaches)

  • Moderator Emeritus
Posted (edited)
On 2016-06-26 at 6:43 AM, rapunzel2 said:

have you found out if valdoxan dissolves in water and can be made to liquid? I have people who ask for advice from me, and I can't answer this particular case about valdoxan. as I understand, it can be cut, but what about liquid?

 

19 hours ago, marx said:

Anyone?..

 

marx: Please go to the top of this page and read ALL the posts. You'll find the answer to your question.

Edited by scallywag

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Posted

Thanks to fuerza. :)

 

11 hours ago, fuerza said:

I make a liquid and measure it out with a syringe. Basically 25mg tablet + 25ml of water. I use hot water, break the pill into little pieces, stir and it's ready in about 5 minutes. There's still a bit residue, but I think it's from the fillers. I've been successful with a liquid taper so far. :)

2016 ~may-june: 25mg valdoxan

2017 ~may: stopped cold turkey

currently going through withdrawal (blurry vision, sensitivity to light, bouts of nausea, headaches)

  • 9 months later...
Posted

Some drugs can make your skin prone to sunburn more easily. Would you say Valdoxan is one of them?
I have skin that gets tanned really fast and I'd never in my life got a sunburn, but after starting a cocktail of Valdoxan, Diazpeam and Olanzapine (last one I've tapered off now), I noticed my skin got burnt for the first time. And not just once. I am not sure whether one of those drugs is/wast the culprit or the synergism of a cocktail of drugs.

 

I am on Valodxan and Diazepam now and I spent 30 minutes working on the balcony in my bikini and I was already spookily dark, so I decided to cover myself up. (I live in Estonia where the sun is not that intense, especially at 2 o'clock in the afternoon).

 

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

  • Administrator
Posted

Please consult Dr. Google about valdoxan's effect on photosensitivity and report back here. Thanks.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Posted

Just checking in a year later to report that I suffered no withdrawal symptoms whatsoever by quitting Valdoxan cold turkey.  

 

 

A closed mouth gathers no feet

  • Administrator
Posted

Good to hear, Rip. We need a lot more information about your Valdoxan -- dosage, length of time on it, etc. Please post details in your Intro topic here http://survivingantidepressants.org/topic/11404-ripvanwinkle/?tab=comments#comment-210501

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

  • 7 months later...
  • Administrator
Posted

FYI, here is the instruction and ordering form for agomelatine tapering strips, currently available in Europe:

 

http://www.taperingstrip.org/wp-content/uploads/2017/07/GMLT_bestel_GB.pdf

 

The first page:
 

Quote

 

Instruction for AGOMELATINE

 

Please ensure you have the correct prescription and order form in front of you. There are several different order forms for

Antidepressants (24), Anti-psychotics (23), Sedatives (19), Anti-epileptics (7), Hormones (1) & Analgetics (4).

 

PLEASE READ CAREFULLY BEFORE FILLING IN THE PRESCRIPTION AND ORDER FORM

 

1. A sudden termination of treatment with agomelatine or a sudden reduction in dosage can lead to significant withdrawal

symptoms. To avoid this, the daily dose should be reduced in small steps gradually over a period of time. This can be done

using tapering strips™.

 

2. One or more tapering strips™ can be used to gradually reduce the dose of agomelatine to a desired lower dose or to zero.

If more than one strip is needed the final dose of the previous strip is always equal to the starting dose of the following

strip.

 

3. The treating physician should plan the tapering schedule together with the patient. It is not possible to predict the perfect

schedule for each patient. Some patients are far more sensitive to withdrawal symptoms than others, and some patients

cope with symptoms better than others. The risk of withdrawal symptoms and their intensity can be reduced by choosing

a more gradual tapering schedule. There are two options when choosing a tapering schedule:

  • Variable - Choose a tapering schedule for the first 28 days only, then use the patient’s experiences and feedback to inform the remainder of the tapering trajectory. To do this only the black part of table 4 on page 4 has to be filled in. The experiences of the patient during the first weeks (withdrawal symptoms or not) can then be used to choose the tapering trajectories for the following strip(s) by filling in in the red part of the table 5 on page 5.
  • Fixed - Choose a tapering schedule for the entire period of the dosage reduction. To do this, fill in both the black and (if applicable) the red part of table 4 on page 4.

4. Agomelatine tapering strips™ are only available on prescription. The signed prescription and order form is seen as a valid

prescription. After filling in the form, the treating physician should terminate any current prescription for agomelatine at

the local pharmacy.

 

5. In most countries, the costs of the medication in the tapering strips™ are covered by health insurance. Tapering and sta-

bilisation strips contain medication for a fixed period of 28 days, all strips have the same price. Tapering strip™: € 77.-;

Stabilization strip € 38.50 for a period of 28 days; Prices are subject to change, so please check before ordering.

 

6. Once the prescription and order form has been received by the Regenboog Apotheek, the tapering strip™ will be shipped

to the patient’s home address within a week.

 

7. A tapering strip™ contains 28 numbered pouches, with each pouch containing several tablets. The number of pills may

vary per day. The total dose of the medication reduces over time as the patient takes the pills in each daily pouch.

 

8. The patient starts their tapering schedule on a Sunday by taking the pills in the first pouch, numbered 028. By counting

down, the patient finishes four weeks later on a Saturday, by taking the pills in the last pouch, numbered 001. By doing

this, the patient can easily keep track of how many doses and days are left.

 

9. Each pouch of the strip is printed with the sequence number, the colour and strength of each tablet, the total number of

tablets and the name of the pharmacy.

 

10. STABILIZATION: A stabilization strip can keep the patient on a fixed dose for a desired period of time. Such stabilization

may be necessary if tapering appears to be going too fast for the patient, or the patient does not wish to reduce the dose

to zero, but remain at an optimal lower dose. The stabilization strip can be produced at almost any desired dose rounded

off to 1 mg agomelatine.

 

11. In some cases, the patient is currently using a dose that is higher or different from the starting dose of the available

tapering strips (see table 4 on page 4). These patients can also reduce their dose gradually by using customized tapering

strips™ for the first part of the taper (see table 4 on page 4).

 

.....

 

 

Interesting that instructions for stabilization are included.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

  • ChessieCat changed the title to Tips for tapering off Valdoxan / agomelatine
  • 3 weeks later...
Posted

I presume this would be close to impossible to get in many or possibly most countries in Europe. Glad the Netherlands have this option.

 

Anyway, I'm just popping in to bump the topic to see if there are any news, new experiences or success stories regarding Valdoxan.

 

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

  • 7 months later...
Posted

Anyone tapering Valdoxan? Just bumping the topic.

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

  • 6 months later...
Posted

Any thoughts and ideas regarding the jumping off dose of Valdoxan?

 

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

  • Moderator
Posted

Do you have any of the tablets leftover and if you do can you measure the average weight of one of them? If we have that information we can calculate a good Target Exit Dose.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Final Dose 0.016mg.     Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

Posted
7 hours ago, brassmonkey said:

Do you have any of the tablets leftover and if you do can you measure the average weight of one of them? If we have that information we can calculate a good Target Exit Dose.

Unfortunately I don't have a scale to measure such light pills.

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

  • Moderator
Posted

Thanks for trying,  I'll do some digging as I get time and see what I can come up with.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Final Dose 0.016mg.     Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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