Agomelatine is a novel and atypical antidepressant that acts as a melatonergic antidepressant and has a distinctly favourable side effect profile. Dr Sanil Rege, Consultant Psychiatrist explains its mechanism of action.
Going to take you through an antidepressant a novel antidepressant called agomelatine countries it comes under the trade name valdoxan names in other countries but essentially uh the different antidepressants that have been prescribed for example ssris snris are the common ones that are prescribed sometimes
Some tricyclic tolerability profile which means obviously a lower incidence of side effects in fact the cipriani meta-analysis which is the network meta-analysis a really really big one comparing the different antidepressants showed that agomelatine ranked right at the top when it came to tolerability
Properties of this antidepressant so in terms of the mechanism of action agomelatine has two main mechanisms one it is a melatonin agonist so what it does is it actually acts on m1 and m2 which are melatonin receptors it actually activates this now we know of course that activating melatonin receptors will help in
Circadian rhythm regulation does not have the antihistaminergic activity amitriptyline does so it’s less likely to lead to that grogginess or sedation that some people can complain of with mirtazapine we have done a video on mirtazapine on this channel so do check that out so it has this m1 m2 agonistic activity
Is one property it has a second property whereby it is a 5 hd2 c this is a specific serotonin receptor it actually antagonizes the receptor so it is a 5 ht 2c antagonist or in other words it blocks the 5 ht2c now interestingly the combination of these two actions results in an antidepressant actually pushes
Dopamine and nor adrenaline levels in the frontal lobe are increased and we know that dopamine and noradrenaline are really necessary or important in a number of frontal lobe functions such as improving hedonic drive which is the ability to experience pleasure focus attention and concentration decision making
And in general improvement of improvement in mood so by m1 m2 agonism 5ht2c antagonistic activity increased levels of noradrenaline and dopamine contributes to its antidepressant properties look out when prescribing agamalatin is to monitor liver function tests so when you start off at 25 milligrams at nighttime
Usually prescribed at night time because of this property of course to promote sleep liver function tests should be carried out at 3 6 12 and 24 weeks if you increase the dose to 50 milligrams which is the recommended maximum dose again blood tests should be done to monitor the liver function test at 3 6 12 and 24
Weeks but in terms of its tolerability profile it does not lead to sexual dysfunction because it does not it actually antagonizes that receptor you see ssris activate this receptor snris activate this receptor and can lead to sexual dysfunction this one blocks it so it’s actually not only can be used as a treatment for
Sexual dysfunction from other antidepressants but on its own it does not lead to sexual dysfunction one two there’s no anti-istaminergic um property so no weight gain three no emotional blunting why because again it does not activate the 5 ht2a receptor which is responsible for emotional blunting so you get
A number of these properties that are beneficial the fourth really important one is it is not associated with a withdrawal syndrome we know ssris and snris are notorious with regards to withdrawal syndromes again we’ve done a video on this as well whilst agomelatine does not is not associated with a withdrawal syndrome
And therefore is lower in the risk when it comes to now if we look at all of these different properties it helps it’s an antidepressant by itself it is also in the guidelines for example australian guidelines to treat anxiety there is evidence in treatment of obsessive-compulsive disorder as well there are some
Case studies where it has shown some benefit in adhd but of course it’s not a routine treatment and in terms of its tolerability profile sexual dysfunction minimized uh withdrawal symptoms minimized no weight gain uh emotional blunting is not a side effect it can be in fact used to treat it so i hope that
This gives you an idea about a novel antidepressant ago melatine that is a useful of course leave us a like don’t forget to subscribe and of course i look forward to until then take care and stay safe bye you
Transcribed from video
How is Agomelatine different from other Antidepressants? | A Psychiatrist Explains | Dr Rege By Dr Sanil Rege’s Hub – Psychiatry Simplified