I recently went to a launch of this product in South Africa. My husband said
he'd never seen me positive about a new drug before - I tend to be very
suspicious, especially of drugs used to treat depressive disorders, as my
belief is they're over-prescribed (Johannesburg is one of the top
anti-depressant hubs in the world). However, this, one seems neatly
targeted, sans serious side effects and has a very short half life in the
body, all of which is appealing. I find the link between sleep disturbance
and depression intuitively and practically right, too. Does anyone on SftP
have any thoughts or info about it?
New anti-depressant claims to put your body clock back on track
New research claims that the recently developed drug agomelatine, which
regulates the internal body clock, has been shown to be as effective in
treatment of depression as standard drugs.
Quality of sleep has long been associated with depression, and people with
depression often find sleep difficult, or tend to sleep too much. Scientists
believe that the new drug may work well because people with depression often
have a disturbed internal body clock (Circadian System) that makes their
symptoms worse.
In a paper recently published by the Lancet, Prof Ian Hickie from the
University of Sydney and Associate Professor Naomi Rogers from Central
Queensland University write:
"Because of its favourable adverse effect and safety profile, and the
potential to help to restore circadian function between depressive episodes,
this drug might occupy a unique place in the management of some patients
with severe depression and other major mood disorders.
Agomelatine appears to not only target the mood symptoms of depression,
but also the circadian and sleep-wake symptoms, which likely contribute to
its effectiveness. Agomelatine is currently approved in the EU, US and
Australia, and represents a significant step forward in the approach to the
treatment of depression, and other mood disorders."
Standard anti-depressants act by increasing the amount of a chemical in the
brain called serotonin, affecting mood. There are many and varied reported
side effects of this type of anti-depressant.
Professor Hickie noted that agomelatine works by targeting a hormone called
melatonin that regulates the internal body clock and therefore may have less
potential for the common gastrointestinal, sexual, or metabolic side-effects
that characterize many other antidepressant compounds.
In an interview with MedPage Today, Hickie stated:
"It's likely that circadian system disturbances contribute to all
syndromes tied to body clock changes, such as bipolar, seasonal affective
disorder, and a range of other sleep disturbances. Therefore, a drug like
agomelatine or melatonin in combination with other appropriate behavioural
strategies, may well prove to be effective not just in those with major
depression, but a number of other key psychiatric conditions."
Agomelatine has been shown to have similar anti-depressant effects to
venlafaxine (Effexor), fluoxetine (Prozac), and sertraline (Zoloft), and one
longer-term study found fewer patients on agomelatine relapsed compared with
those on placebo (23.9% versus 50%).
Agomelatine also improved sleep quality and reduced waking after sleep
onset, the researchers said.
The treatment rationing body, Nice, is currently assessing whether or not
agomelatine should be recommended to the NHS for patients with depression.
The research claims should be balanced against the fact that the authors
have a close relationship with the manufacturers Servier.1 Also, MTRAC, an
independent reviewer of medicines for primary care determined that the
current evidence for agomelatine's efficacy and safety was inadequate.2
Sources
The Lancet - Hickie IB, Rogers NL. (2011). Novel melatonin-based therapies:
potential advances in the treatment of major depression. Available:
http://dx.doi.org/10.1016/S0140-6736(11)60095-0. Last accessed 24th May
2011.
Fiore, Kristina . (2011). APA: Circadian System May Be Target in Depression.
Available: http://www.medpagetoday.com/Psychiatry/Depression/26538. Last
accessed 24th May 2011.
1Ian Hickie is a participant in a family-practice-based audit of sleep
disturbance and major depression, supported by Servier, the manufacturers of
agomelatine. Naomi Rogers has received grant support from Vanda
Pharmaceuticals, Servier, Pfizer, and Cephalon, and has received honoraria
for lectures from Pfizer, CSL Biotherapies, and Servier. She has previously
received research funding from Vanda Pharmaceuticals, manufacturers of
tasimelteon. She has also received an unrestricted educational grant from
Servier. Research studies done by Ian Hickie and Naomi Rogers are mainly
funded by NHMRC project and program grants.
2http://195.62.199.219/pctsla/mtrac/productinfo/verdicts/A/Agomelatine.pdf
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