Positives

• Roughly 82% of patients in a naturalistic study reported improvement in difficulty falling asleep and repeated night awakenings, with sleep quality gains in the first week and no daytime clumsiness PMC.
  
  
• Patients welcomed avoiding SSRI-style sexual dysfunction, weight gain, GI upset, and serotonin syndrome Psychiatry Online.
  
  

Negatives

• A patient reported headache, dizziness, somnolence, nausea, and paradoxically worsened insomnia among the most common adverse effects PMC.
  
  
• Online reviewers described highly variable mood and sleep results depending on individual response Drugs.com.
  
  

Hurdles & Side Effects

• Patients are required to undergo periodic liver-function blood tests due to hepatotoxicity risk on ongoing dosing Wikipedia.
  
  
• U.S. patients faced access difficulties because the drug is not FDA-approved and must be sourced through European or compounding channels PMC.