Editorials

Does agomelatine have a place in the treatment of depression?

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2157 (Published 20 March 2014) Cite this as: BMJ 2014;348:g2157
  1. Gilles Ambresin, senior lecturer, honorary research fellow12,
  2. Jane Gunn, chair of primary care research 2
  1. 1Psychiatry and Psychotherapy Consultation Centre, Department of Psychiatry-CHUV, University of Lausanne, Switzerland
  2. 2General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
  1. gilles.ambresin{at}chuv.ch

Only as an alternative second line therapy for those with severe symptoms

Depression is mainly managed in primary care,1 2 and antidepressant medication is the most common treatment used in this setting in the developed world.3 Current clinical guidelines recommend that primary care doctors consider prescribing antidepressants for adults with major depressive disorder and dysthymia.4 5 Recent research suggests that the efficacy of antidepressants may have been overestimated because of publication bias—the tendency for positive trials to have a higher likelihood of publication than negative trials.6 7 While some criticism remains about the analytical techniques used, in particular by Kirsch et al,8 the balance of evidence does support the view that the benefits of these agents have been overestimated and further suggests that they are more effective for people with severe depressive disorder and less effective for those with mild to moderate depressive disorder.

These findings have important implications for primary care, where most depression is managed, and paves the way for research into new and more effective treatments. Agomelatine, which acts via the melatonergic system, has been promoted as an alternative to second generation antidepressants (selective serotonin reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors) with a different side effect profile. …

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