Impact of the novel antidepressant agomelatine on disturbed sleep-wake cycles in depressed patients

• Published in: Human psychopharmacology 2010-04, Vol.25 (3), p.222-229
• Main Authors: Quera-Salva, Maria-Antonia, Lemoine, Patrick, Guilleminault, Christian
• Format: Article
• Language: English
• Subjects: Acetamides - pharmacology; Acetamides - therapeutic use; agomelatine; Animals; antidepressant; Antidepressive Agents - pharmacology; Antidepressive Agents - therapeutic use; Depressive Disorder, Major - complications; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - psychology; Humans; Leeds Sleep Evaluation Questionnaire; major depressive disorder; Melatonin - agonists; polysomnography; Randomized Controlled Trials as Topic - methods; Sleep Disorders, Circadian Rhythm - complications; Sleep Disorders, Circadian Rhythm - drug therapy; Sleep Disorders, Circadian Rhythm - psychology; Sleep Wake Disorders - complications; Sleep Wake Disorders - drug therapy; Sleep Wake Disorders - psychology; sleep-wake cycle
• ISSN: 0885-6222; 1099-1077
• DOI: 10.1002/hup.1112

Background 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 MT1 and MT2 receptor agonist and 5‐HT2C 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. Subjective measures 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. Objective measures 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. Conclusion 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. Copyright © 2010 John Wiley & Sons, Ltd.