Agomelatine is a novel antidepressant that is currently approved in Europe and under review for approval in the United States. A melatonin MT1 and MT2 agonist and 5-HT2C antagonist, agomelatine has demonstrated efficacy in depressed patients and has a favorable side-effect profile with no daytime sedation. Agomelatine produces both subjective and objective improvements in sleep, with increased slow-wave sleep and improved sleep quality and continuity, with no effect on REM sleep. Agomelatine’s mechanism of action—melatonin agonism—and antidepressant efficacy reinforces the comorbid and interconnected nature of sleep disturbance and mood disorders, and further demonstrates the role of antidepressants in the treatment of insomnia. Agomelatine is a promising medication for the treatment of depression-related insomnia, and appears equally promising for the treatment of primary insomnia.
Agomelatine has a beneficial effect also on the anxiety symptoms frequently associated with depression. The ‘effect size’ of agomelatine in the treatment of major depression was evaluated by some authors as being small in comparison with other antidepressants. On the other hand, current meta-analysis of published and unpublished studies of agomelatine in people with depression showed that agomelatine was significantly more effective than placebo and equally effective compared with other antidepressants. more info
Agomelatine is an antidepressant with unique pharmacological actions; it is both a melatonin agonist and selective serotonin antagonist. Both actions combined are necessary for antidepressant efficacy. Effects on melatonin receptors enable resynchronisation of disrupted circadian rhythms with beneficial effects on sleep patterns.
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