Potměšil Petr
Department of Pharmacology, Charles University, Third Faculty of Medicine, Ruská 87, 100 00 Prague 10, Czech Republic.
Department of Pharmacology and Toxicology, Charles University, Faculty of Medicine in Pilsen, alej Svobody 1655/76, 323 00 Pilsen, Czech Republic.
Ther Adv Psychopharmacol. 2019 Jul 7;9:2045125319855206. doi: 10.1177/2045125319855206. eCollection 2019.
Even with many antidepressant and anxiolytic drugs available on the market, there are still patients who do not respond well to the standard first or second line treatments for affective or anxiety disorders. The antidepressant agomelatine has been used in Europe for several years. Agomelatine, an agonist at melatonin receptors and an antagonist at serotonin receptors, can be particularly useful in patients suffering from a major depressive disorder associated with insomnia. Some clinical data have shown a limited effect for agomelatine in a subset of patients with major depression. A number of case reports published in 2011-2016 describe the effect of agomelatine in combination with an established antidepressant, such as escitalopram, venlafaxine, duloxetine, moclobemide or bupropion. A successful combination of agomelatine was reported after adjunctive use of agomelatine combined with clomipramine, escitalopram, and venlafaxine in patients with major depression or obsessive-compulsive disorder. Moreover, bupropion or moclobemide augmentation with agomelatine in patients with major depressive disorder led to a significant improvement. Other supportive data have been published, such as analysis of the VIVALDI study, although it should be noted that the study was supported by the manufacturer of agomelatine. In this study, agomelatine in combination with other antidepressants was shown to be effective and well tolerated in practice, although the most effective antidepressant treatment in the study consisted of agomelatine alone and not in combination with other antidepressants. There have also been two published case reports about the concomitant use of duloxetine and agomelatine which were not efficacious. The positive results of agomelatine augmentation with other antidepressants should be confirmed through randomized, double-blind clinical trials.
尽管市面上有许多抗抑郁药和抗焦虑药，但仍有一些患者对情感障碍或焦虑症的标准一线或二线治疗反应不佳。抗抑郁药阿戈美拉汀已在欧洲使用数年。阿戈美拉汀是褪黑素受体激动剂和5-羟色胺受体拮抗剂，对患有与失眠相关的重度抑郁症的患者可能特别有用。一些临床数据显示阿戈美拉汀对部分重度抑郁症患者的疗效有限。2011年至2016年发表的一些病例报告描述了阿戈美拉汀与已有的抗抑郁药（如艾司西酞普兰、文拉法辛、度洛西汀、吗氯贝胺或安非他酮）联合使用的效果。据报道，在重度抑郁症或强迫症患者中辅助使用阿戈美拉汀联合氯米帕明、艾司西酞普兰和文拉法辛后取得了成功的联合治疗效果。此外，在重度抑郁症患者中，用阿戈美拉汀增强安非他酮或吗氯贝胺的疗效可导致显著改善。还发表了其他支持性数据，如对VIVALDI研究的分析，不过应该指出的是，该研究由阿戈美拉汀制造商资助。在这项研究中，阿戈美拉汀与其他抗抑郁药联合使用在实践中显示出有效且耐受性良好，尽管该研究中最有效的抗抑郁治疗是单独使用阿戈美拉汀而非与其他抗抑郁药联合使用。也有两篇关于度洛西汀和阿戈美拉汀联合使用无效的病例报告发表。阿戈美拉汀与其他抗抑郁药联合增强疗效的阳性结果应通过随机双盲临床试验予以证实。
