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Agomelatine
1. AGOMELATINE
More Than Just Another Antidepressant
Venue: Samson H. Chowdhury Hall
Dhaka Club
Date: 19 January, 2022
2. Agomelatine
More than just another antidepressant
Dr. Ahsan Aziz Sarkar
Assistant Registrar, Psychiatry (FCPS, MCPS)
National Institute of Mental Health, Dhaka
3. Common
problems we
face with
antidepressants
Some issues
with
antidepressants
Treatment
resistance
Cardiac effect
Anticholinergic
effect, cognitive
impairment
Discontinuation
syndrome
Sexual
dysfunction,
suicide risk
Weight gain
4. History
Structural analog of melatonin.
First developed in 2005.
Got approval for clinical use in European Union in
2009.
5. Mechanism of
action
MT1 and MT2
melatonin agonist
Resynchronization
of circadian rhythm
5-HT2c antagonist
Increase
noradrenaline and
dopamine in
frontal cortex.
5-HT2A agonist
Decrease 5-HT
firing
Enhance BDNF
May promote
neurogenesis
11. Comparing
side effects
Agomelatine Nortriptyline Sertraline
Anticholinergic 0 2+ 0
Insomnia/
agitation
1+ 0 2+
QT
prolongation
0 1+ 1+
GIT symptoms 1+ 0 2+
Weight gain 0 1+ 1+
Sexual
dysfunction
0 Inadequate data 3+
12. Potentially
serious adverse
effect
Elevated transaminase in 1% of recipients (0.7% in placebo group).
Idiosyncratic reaction.
Needs to measure transaminase level at baseline, 6, 12 and 24
weeks.
Drug stoppage leads to normalization of transaminase level.
15. Advantages
Well tolerated.
Fast action.
Effective in preventive relapse.
Less chance of manic switch.
No discontinuation syndrome.
No sexual side effects.
No weight gain.
Little drug interaction.
Not cardiotoxic, safe in overdose.
Little initial agitation.
16. Concerns
Most trials are on patients with moderate to severe depression.
Modest efficacy.
In case of non-response to initial antidepressant, combination
therapy might be necessary (e.g., SSRI + agomelatine, Bupropion
+ agomelatine).
Need for LFT monitoring.
17. Dosing
Strength – 25mg
Once daily dosing at bedtime (9 PM).
Increase dose to 50mg if no response after two weeks.