Agomelatine in the treatment of seasonal affective disorder.
BACKGROUND
The novel antidepressant agomelatine acts as a melatonergic (MT(1) and MT(2)) receptor agonist and as a serotonin-2C receptor antagonist. Previous studies showed that agomelatine is able to restore disrupted circadian rhythms, which were implicated in the pathophysiology of seasonal affective disorder (SAD).


OBJECTIVE
The aim of this study was to investigate the efficacy and tolerability of agomelatine in the treatment of SAD.


METHODS
Thirty-seven acutely depressed SAD patients were included in an open study with agomelatine (25 mg/day in the evening) over 14 weeks. Efficacy assessments included the Structured Interview Guide for the Hamilton Depression Rating Scale (SAD version; SIGH-SAD), the Clinical Global Impression of Severity (CGI-S) and Improvement (CGI-I), the Circscreen, a self-rating scale for the assessment of sleep and circadian rhythm disorders, and the Hypomania Scale.


RESULTS
Agomelatine led to a progressive and statistically significant decrease of SIGH-SAD, CGI-S, and CGI-I scores from week 2 onward (p < 0.001). Furthermore, scores on the Circscreen improved significantly during the study (p < 0.001). Treatment with agomelatine over 14 weeks yielded a response rate of 75.7% (SIGH-SAD <50% of baseline value) and a remission rate (SIGH-SAD <8) of 70.3% in the intention to treat sample. Scores on the Hypomania Scale were consistently low during the study. Agomelatine showed good overall tolerability: throughout the study only one adverse event (mild fatigue) was related to the study drug.


CONCLUSIONS
The results of this study suggest that seasonal depression may be effectively and safely treated with agomelatine.
Pjrek
Edda
E
Department of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria. edda.pjrek@meduniwien.ac.at
Winkler
Dietmar
D
Konstantinidis
Anastasios
A
Willeit
Matthäus
M
Praschak-Rieder
Nicole
N
Kasper
Siegfried
S
D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002940:Circadian Rhythm / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D044122:Receptor, Melatonin, MT1 / Q000819:agonists; D044123:Receptor, Melatonin, MT2 / Q000819:agonists; D016574:Seasonal Affective Disorder / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D058830:Serotonin 5-HT2 Receptor Antagonists; D012890:Sleep / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D009281:Naphthalenes
D000081:Acetamides; D000928:Antidepressive Agents; D044122:Receptor, Melatonin, MT1; D044123:Receptor, Melatonin, MT2; D058830:Serotonin 5-HT2 Receptor Antagonists; C084711:agomelatine; D009281:Naphthalenes