Melatonergic Antidepressant Agomelatine and Its Efficacy in Depressive Disorders

Abstract

A majority of available antidepressant drugs produce unwanted negative effects on sleep. An ideal antidepressant should mitigate the symptoms of depression with improvement of sleep quality and efficiency. Agomelatine is one of the melatonergic analogues that acts specifically on MT1/MT2 melatonergic receptors and at the same time exhibits 5-HT2C antagonism. It also plays an important role in resetting the desynchronized circadian rhythms and disturbed sleep-wake cycles. It has been shown to be effective in a number of animal models of depression and clinical studies in patients with depressive disorders. Clinical studies undertaken on patients with major depressive disorders (MDD), bipolar depression, and seasonal affective disorder (SAD) have shown that agomelatine is clinically very effective in reducing depressive symptoms. It improved sleep efficiency and resynchronized the disrupted circadian rhythms in some studies. Agomelatine also manifests early onset of action with good tolerability and safety profile comparable to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) antidepressants. But unlike these drugs, agomelatine does not exhibit adverse effects like worsening of insomnia or sexual problems. Agomelatine stands as a unique choice in antidepressant therapy based upon its diversified actions on various parameters such as (a) improving sleep efficiency, (b) resynchronization of disrupted circadian systems, and (c) enhancing hippocampal dendritic maturation.