Quera-Salva Maria-Antonia, Lemoine Patrick, Guilleminault Christian
Sleep Unit, Raymond Poincaré Hospital, Garches, APHP, France.
Hum Psychopharmacol. 2010 Apr;25(3):222-9. doi: 10.1002/hup.1112.
Disturbance of sleep-wake cycles is common in major depressive disorder (MDD), usually as insomnia, but also as hypersomnia or reduced daytime alertness. Agomelatine, an MT(1) and MT(2) receptor agonist and 5-HT(2C) receptor antagonist, represents a novel approach in MDD, with proven antidepressant efficacy and a positive impact on the sleep-wake cycle. We review the effects of agomelatine 25/50 mg/day on objective and subjective measures of the sleep-wake cycle in MDD.
Agomelatine improved all aspects of the sleep-wake cycle from as early as 1 week in randomized trials versus selective serotonin reuptake inhibitors and venlafaxine, particularly getting off to sleep and quality of sleep, with an improvement in daytime alertness.
Agomelatine's effect on sleep architecture in MDD has been measured by polysomnography (PSG). There were significant improvements in sleep efficiency, slow-wave sleep (SWS), and the distribution of delta activity throughout the night, but no change in amount or latency of rapid eye movement (REM) sleep. Furthermore, the slow-wave sleep was resynchronized to the first sleep cycle of the night.
Agomelatine, a novel antidepressant, improves disturbed sleep-wake cycles in MDD. The improvement of both nighttime sleep and daytime functioning with agomelatine are promising features of this antidepressant regarding the management of MDD.
睡眠-觉醒周期紊乱在重度抑郁症（MDD）中很常见，通常表现为失眠，但也有表现为嗜睡或日间警觉性降低的情况。阿戈美拉汀是一种褪黑素MT(1)和MT(2)受体激动剂及5-羟色胺2C（5-HT(2C)）受体拮抗剂，是治疗MDD的一种新方法，已证实具有抗抑郁疗效，并对睡眠-觉醒周期有积极影响。我们回顾了阿戈美拉汀25/50毫克/天对MDD患者睡眠-觉醒周期的客观和主观指标的影响。
在随机试验中，与选择性5-羟色胺再摄取抑制剂及文拉法辛相比，阿戈美拉汀早在1周时就能改善睡眠-觉醒周期的各个方面，尤其是入睡情况和睡眠质量，同时日间警觉性也有所改善。
已通过多导睡眠图（PSG）测量了阿戈美拉汀对MDD患者睡眠结构的影响。睡眠效率、慢波睡眠（SWS）以及夜间δ波活动分布均有显著改善，但快速眼动（REM）睡眠的时长或潜伏期没有变化。此外，慢波睡眠重新同步到夜间的第一个睡眠周期。
新型抗抑郁药阿戈美拉汀可改善MDD患者紊乱的睡眠-觉醒周期。阿戈美拉汀对夜间睡眠和日间功能的改善是这种抗抑郁药在MDD治疗方面的有前景的特征。
