Abstract
Agomelatine is the first MASSA (Melatonin Agonist and Selective Serotonin Antagonist) antidepressant with novel mechanism of action. It displays higher affinity to melatonin (MT-1 and MT-2 agonism) than serotonergic (5-HT2C antagonism) receptors.
Acute antidepressive efficacy was tested in the total of 14 randomized double-blind trials with 5300 depressed in- and out-patients. Head-to-head comparison with other antidepressants (fluoxetine, sertraline, venlafaxine) suggested comparable efficacy; moreover, in 2 studies agomelatine showed its superiority.
Agomelatine was effective in severe depression and has anxiolytic effects and improves sleep disorders. Onset of antidepressive action can be detected after 2 weeks of administration.
Agomelatine has lower incidence of gastrointestinal and sexual side effects, daytime sedation, weight change, and withdrawal symptoms than other antidepressants. To establish unequivocal long-term and relapse-prevention efficacy, together with effects and tolerability in special patient subpopulations, additional clinical trials are needed.