Kasper Siegfried, Hamon Michel
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
World J Biol Psychiatry. 2009;10(2):117-26. doi: 10.1080/15622970902717024.
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.
开发更有效、耐受性更好且起效更快的抗抑郁药存在诸多潜力。由于包括抑郁症在内的各种情感障碍中昼夜节律功能障碍的患病率很高,一种方法是开发具有褪黑素能激动剂特性的抗抑郁药。阿戈美拉汀具有褪黑素能激动作用(作用于MT(1)和MT(2)受体)以及5-HT(2C)拮抗特性,代表了一种治疗抑郁症的新概念。阿戈美拉汀的抗抑郁作用最初在抑郁症动物模型中得到证实,如强迫游泳、习得性无助和慢性轻度应激范式。随后的研究表明,阿戈美拉汀的抗抑郁活性不仅取决于其对褪黑素能受体的激动作用,还取决于其对5-HT(2C)受体的拮抗活性。阿戈美拉汀还表现出与选择性5-HT(2C)受体拮抗剂相似的抗焦虑特性。在重度抑郁症患者中,阿戈美拉汀的疗效至少与现有抗抑郁药相当。有趣的是,阿戈美拉汀不仅在中度抑郁发作患者中显示出抗抑郁疗效,在病情更严重的抑郁亚组患者中也有疗效。治疗效果随疾病严重程度增加。阿戈美拉汀还能快速调节睡眠-觉醒周期而不引起镇静,并改善日间状况。阿戈美拉汀具有出色的安全性,对体重无影响,不影响性功能,也不会引起停药综合征。总体而言,其疗效以及出色的耐受性使阿戈美拉汀在不久的将来成为一种特别有前景的抗抑郁药。