Agomelatine: a novel antidepressant

Depression is highly prevalent in community and primary care samples. According to the findings of the Sequential Treatment Alternatives to Relieve Depression study, after multiple clinical interventions, approximately one-third of patients never fully experienced remission from depression. This somber finding invites consideration of novel antidepressant options, which may in the near future include agomelatine. Agomelatine is a melatonergic agonist and a 5HT(2c) antagonist (i.e., it has a unique mechanism of action). The melatonergic function appears to improve sleep patterns, whereas the serotonergic antagonism results in the release of norepinephrine and dopamine. Given the current information, the overall side-effect profile of agomelatine appears relatively mild. For example, agomelatine has no discontinuation syndrome, exhibits infrequent sexual dysfunction, and is generally weight neutral. The drug appears to be relatively safe in overdose. On a cautionary note, however, one percent of patients experience elevated hepatic transaminases while on treatment. Overall, agomelatine may be a unique pharmacological addition in the clinical war on depression in both psychiatric and primary care settings-if further evaluation in clinical trials supports reasonable risk.