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How is Agomelatine different from other Antidepressants? | A Psychiatrist Explains | Dr Rege

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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