The use of antidepressants in clinical practice: focus on agomelatine.
OBJECTIVE
Agomelatine (Valdoxan) is licensed by the European Medicines Agency for the treatment of major depressive episodes in adults. The objective of this review was to consider how the drug should be used in clinical practice in particular starting, stopping and switching to and from the drug.


METHODS
The existing clinical evidence was reviewed.


RESULTS
Data suggest that when switching to agomelatine from other antidepressants consideration should be given to tapering the previous antidepressant in order to minimize the risk of the original drug causing discontinuation/withdrawal symptoms. The risk of pharmacological interactions between most antidepressants and agomelatine is low and so tapering the previous antidepressant can usually be done after agomelatine has been started. An exception is fluvoxamine which should not be concurrently prescribed with agomelatine. As agomelatine appears to cause no significant discontinuation symptoms, it can probably be stopped abruptly when treatment is completed or when switching to another antidepressant.


CONCLUSIONS
While this guidance may change as clinical evidence and experience grows, currently agomelatine appears to have a good tolerability profile and is relatively easy to use, though prescribers should note the requirement to conduct liver function tests (LFTs) in accordance with the Summary of Product Characteristics (SPC).
McAllister-Williams
R H
RH
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. r.h.mcallister-williams@newcastle.ac.uk
Baldwin
D S
DS
Haddad
P M
PM
Bazire
S
S
D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000818:Animals; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000075202:Contraindications; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004347:Drug Interactions; D016903:Drug Monitoring; D016666:Fluvoxamine; D006801:Humans; D008099:Liver / Q000187:drug effects; D044122:Receptor, Melatonin, MT1 / Q000819:agonists; D044123:Receptor, Melatonin, MT2 / Q000819:agonists; D058830:Serotonin 5-HT2 Receptor Antagonists; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control; D009281:Naphthalenes
D000081:Acetamides; D000928:Antidepressive Agents; D016666:Fluvoxamine; D044122:Receptor, Melatonin, MT1; D044123:Receptor, Melatonin, MT2; D058830:Serotonin 5-HT2 Receptor Antagonists; C084711:agomelatine; D009281:Naphthalenes