Beyond the monoaminergic hypothesis: Agomelatine, a new antidepressant with an innovative mechanism of action
Kasper S, Hamon M.
Department of Psychiatry and Psychotherapy,
Medical University of Vienna,
Vienna, Austria.
World J Biol Psychiatry. 2009 Mar 2:1-11.


There are many potentials for the development of more effective, better tolerated, and more rapidly acting antidepressants. As there is large prevalence of circadian dysfunction in various affective disorders, including depression, one of the approaches is the development of antidepressant drugs with melatonergic agonist properties. Agomelatine, with its melatonergic agonistic (at both MT(1) an MT(2) receptors) and 5-HT(2C) antagonistic properties, represents a new concept for the treatment of depression. The antidepressant action of agomelatine has been initially demonstrated in animal models of depression, such as the forced swim - the learned helplessness - and the chronic mild stress paradigms. Subsequent studies demonstrated that the antidepressant activity of agomelatine does not solely depend on its agonistic action at melatonergic receptors, but also on its antagonistic activity at 5-HT(2C) receptors. Agomelatine also exhibits anxiolytic properties that bear a striking resemblance to those of selective 5-HT(2C) receptor antagonists. In patients with major depressive disorder, agomelatine had efficacy at least comparable to that seen with available antidepressants. Interestingly, agomelatine demonstrated antidepressant efficacy not only in patients with a moderate depressive episode but also in a more severe depressed subpopulation of patients. The treatment effect increased with the severity of the disease. Agomelatine also rapidly regulates the sleep-wake cycle without causing sedation and improves daytime condition. Agomelatine has an excellent safety profile, is weight neutral, does not affect sexual functioning and does not cause discontinuation syndrome. Collectively, its efficacy, together with its excellent tolerability, makes agomelatine an especially promising antidepressant for the near future.
Agomelatine: structure
Agomelatine, stress and memory
New antidepressants: agomelatine
Agomelatine (Valdoxan) and melatonergic drugs
Agomelatine (Valdoxan): efficacy and tolerance profile
Agomelatine, 5-HT2c antagonist and melatonin agonist
Agomelatine in the treatment of seasonal affective disorder (SAD)
Agomelatine (Valdoxan, Melitor, Thymanax) to treat major depression
Agomelatine (Valdoxan) and the serotonin 5-HT2b and 5-HT2c receptors
Pathophysiology of depression: Role of sleep and the melatonergic system
Jet lag: therapeutic use of melatonin and possible application of melatonin analogs

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