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Guo YH, Zhou L, Cui ZA, Wang J, Zhang L, Xu T, Xie YD, Chen H. Efficacy and safety of agomelatine in the treatment of patients with depressive disorder: A meta-analysis. Medicine (Baltimore) 2023; 102:e35871. [PMID: 37960759 PMCID: PMC10637518 DOI: 10.1097/md.0000000000035871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To systematically assess the efficacy and safety of agomelatine in the treatment of patients with depressive disorder. METHODS Randomized controlled trials (RCTs) related to agomelatine in the treatment of patients with depressive disorder published in PubMed, Web of Science, CNKI, VIP, and Wangfang were retrieved. Extracted data on the efficacy and safety of agomelatine and placebo in the treatment of depressive disorder, and the collected data were processed by RevMan5.4 software. RESULTS A total of 10 RCTs were included. Meta-analysis showed that the HAMD-17 total scores of agomelatine group were statistically different from those of placebo group (odds ratio [OR]: 2.04, 95% confidence intervals [CIs]: 1.71-2.43, P < .001). High heterogeneity was found between agomelatine groups and placebo groups (P < .0001, and I2 = 78%), so a subgroup analysis was further performed, and the heterogeneity became insignificant (P = .33, and I2 = 14%) after excluding the studies, of which course of treatment was 24 weeks or the sample size was relatively small. The adverse events between agomelatine and placebo groups were not statistically significant (OR: 1.15, 95% CIs: 0.69-1.92; P = .05). CONCLUSION Agomelatine was superior comparable to placebo in the treatment of patients with depressive disorder, and has fewer adverse events.
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Affiliation(s)
- Yue-Han Guo
- Department of Pharmacy, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Le Zhou
- Department of Pharmacy, Wuhan No.9 Hospital, Wuhan, Hubei, China
| | - Zi-Ang Cui
- Department of Psychosomatic Clinic, Beijing Jingmei Group General Hospital, Beijing, China
| | - Jian Wang
- Department of Pharmacy, Harbin First Specialized Hospital, Harbin, Heilongjiang, China
| | - Lei Zhang
- Department of Pharmacy, Affiliated Hospital of Hubei University of Medicine, Xiangyang, Hubei, China
| | - Ting Xu
- Department of Pharmacy, China Resources WISCO General Hospital, Wuhan, Hubei, China
| | - Yi-Dan Xie
- Department of Pharmacy, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, Guangdong, China
| | - Hui Chen
- Department of Pharmacy, Wuhan Mental Health Center, Wuhan, Hubei, China
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Kremer S, Wiesinger T, Bschor T, Baethge C. Antidepressants and Social Functioning in Patients with Major Depressive Disorder: Systematic Review and Meta-Analysis of Double-Blind, Placebo-Controlled RCTs. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:304-314. [PMID: 37725934 DOI: 10.1159/000533494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/05/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Social functioning (SF) is the ability to fulfil one's social obligations and a key outcome in treatment. OBJECTIVE The aim of the study was to estimate the effects of antidepressants on SF in patients with major depressive disorder (MDD). METHODS This meta-analysis and its reporting are based on Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF). We systematically searched CENTRAL, Medline, PubMed Central, and PsycINFO for double-blind RCTs comparing antidepressants with placebo and reporting on SF. We computed standardized mean differences (SMDs) with 95% CIs and prediction intervals. RESULTS We selected 40 RCTs out of 1,188 records screened, including 16,586 patients (mean age 46.8 years, 64.2% women). In 27 studies investigating patients with MDD (primary depression), antidepressants resulted in a SMD of 0.25 compared to placebo ([95% CI: 0.21; 0.30] I2: 39%). In 13 trials with patients suffering from MDD comorbid with physical conditions or disorders, the summary estimate was 0.24 ([0.10; 0.37] I2: 75%). In comorbid depression, studies with high/uncertain risk of bias had higher SMDs than low-risk studies: 0.29 [0.13; 0.44] versus 0.04 [-0.16; 0.24]; no such effect was evident in primary depression. There was no indication of sizeable reporting bias. SF efficacy correlated with efficacy on depression scores, Spearman's rho 0.67 (p < 0.001), and QoL, 0.63 (p < 0.001). CONCLUSIONS The effect of antidepressants on SF is small, similar to its effect on depressive symptoms in primary MDD, and doubtful in comorbid depression. Strong correlations with both antidepressive and QoL effects suggest overlap among domains.
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Affiliation(s)
- Stefanie Kremer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Teresa Wiesinger
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany
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3
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Rozjabek H, Li N, Hartmann H, Fu DJ, Canuso C, Jamieson C. Assessing the meaningful change threshold of Quality of Life in Depression Scale using data from two phase 3 studies of esketamine nasal spray. J Patient Rep Outcomes 2022; 6:74. [PMID: 35816217 PMCID: PMC9273809 DOI: 10.1186/s41687-022-00453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Major depressive disorder (MDD) directly impacts patients’ lives including symptoms, functioning and health-related quality-of-life (HRQoL). Patient-reported outcomes can capture these impacts, however interpretation of clinical meaningfulness of these measurements are often not readily available. Meaningful change thresholds (MCTs) can be derived for clinical outcome assessments to quantify the change in symptoms that is meaningful to the patient following pharmacologic treatment or other interventions. The objective of this analysis was to determine the within-patient MCT of the self-reported Quality-of-Life in Depression Scale (QLDS) among patients with MDD and active suicidal ideation with intent (MDSI) using an anchor-based approach. Methods Data from 2 randomized phase-3 trials of esketamine nasal spray (ASPIRE I and ASPIRE II) were analyzed. The Montgomery–Åsberg Depression Rating Scale (MADRS) was the primary anchor with three different severity criteria. Other anchor variables utilized were Clinical Global Impression of Severity of Suicidality-revised version, Clinical Global Impression of Imminent Suicide Risk, and EuroQol Visual Analog Scale [EQ-VAS]. Spearman correlation coefficients between the change in QLDS and anchor variables were calculated. The mean change in QLDS score at Day 25 from baseline was calculated based on the categorical change in the anchor. Coefficient yield from linear regression of the mean changes in EQ-VAS and QLDS, and distribution-based approach with ½ SD of change in QLDS were considered. Results In ASPIRE I, mean (SD) improvement in QLDS score among patients with one category improvement in MADRS from baseline to Day 25 was − 8.22 (8.87), − 8.30 (9.01), and − 8.20 (8.92) using severity criteria #1, #2, and #3, respectively. Patients who achieved a 7-point improvement (MCT) in EQ-VAS yielded a mean − 9.69-point improvement in QLDS at Day 25. The ½ SD of change in QLDS was 5.63. Similar results were obtained for ASPIRE II. The MCTs identified using multiple anchors across both trials ranged from − 11.4 to − 6.7 and had an overall mean of − 7.90 (ASPIRE I) and − 7.92 (ASPIRE II). Thus, an 8-point change was recommended as the MCT for QLDS. Conclusion The recommended MCT will help quantify within-person changes in HRQoL using patient-reported QLDS and determine meaningful treatment benefit in an MDD patient population with acute suicidal ideation or behavior.
Trial registration: Name of the registry: ClinicalTrials.gov. Trial registration number: ASPIRE I (NCT03039192), ASPIRE II (NCT03097133). Date of registration: February 01, 2017; March 31, 2017. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03039192; https://clinicaltrials.gov/ct2/show/NCT03097133.
Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00453-y.
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Naveed M, Li LD, Sheng G, Du ZW, Zhou YP, Nan S, Zhu MY, Zhang J, Zhou QG. Agomelatine: An astounding sui-generis antidepressant? Curr Mol Pharmacol 2021; 15:943-961. [PMID: 34886787 DOI: 10.2174/1874467214666211209142546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/09/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
Major depressive disorder (MDD) is one of the foremost causes of disability and premature death worldwide. Although the available antidepressants are effective and well tolerated, they also have many limitations. Therapeutic advances in developing a new drug's ultimate relation between MDD and chronobiology, which targets the circadian rhythm, have led to a renewed focus on psychiatric disorders. In order to provide a critical analysis about antidepressant properties of agomelatine, a detailed PubMed (Medline), Scopus (Embase), Web of Science (Web of Knowledge), Cochrane Library, Google Scholar, and PsycInfo search was performed using the following keywords: melatonin analog, agomelatine, safety, efficacy, adverse effects, pharmacokinetics, pharmacodynamics, circadian rhythm, sleep disorders, neuroplasticity, MDD, bipolar disorder, anhedonia, anxiety, generalized anxiety disorder (GAD), and mood disorders. Agomelatine is a unique melatonin analog with antidepressant properties and a large therapeutic index that improves clinical safety. It is a melatonin receptor agonist (MT1 and MT2) and a 5-HT2C receptor antagonist. The effects on melatonin receptors enable the resynchronization of irregular circadian rhythms with beneficial effects on sleep architectures. In this way, agomelatine is accredited for its unique mode of action, which helps to exert antidepressant effects and resynchronize the sleep-wake cycle. To sum up, an agomelatine has not only antidepressant properties but also has anxiolytic effects.
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Affiliation(s)
- Muhammad Naveed
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Lian-Di Li
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Gang Sheng
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Zi-Wei Du
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Ya-Ping Zhou
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Sun Nan
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Ming-Yi Zhu
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Jing Zhang
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
| | - Qi-Gang Zhou
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166. China
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5
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Maddukuri RK, Hema C, Sri Tejaswi K, Venkata Mounika M, Vegesana BP. Antidepressant efficacy of Agomelatine: Meta-analysis of placebo controlled and active comparator studies. Asian J Psychiatr 2021; 65:102866. [PMID: 34592623 DOI: 10.1016/j.ajp.2021.102866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Agomelatine is a novel antidepressant that was developed to counter the adverse effects associated with the standard SSRIs and SNRIs that limited their usage. Publication bias was identified in antidepressant trials which can potentially overestimate the treatment efficacy. This meta-analysis was designed to assess the overall antidepressant effect of Agomelatine by pooling all the published and unpublished studies available till date. Studies conducted on adult patients who met with the criteria for MDD that evaluated efficacy of Agomelatine at acute phase (6-12weeks) and at long term phase (24weeks) were included. The primary efficacy measured with SMD of final mean scores of HAM-D and MADRS. Secondary efficacy measures of Response, remission and safety parameters were evaluated with relative risks. RevMan version 5.4 was used for analysis of both continuous (Standardized mean difference) and dichotomous outcomes (response, remission and all cause of discontinuation). Efficacy parameters were presented with 99% confidence intervals while safety parameters were presented with 95% CI. A total of 9233 patients were included from 27 studies. In acute phase placebo controlled studies, Agomelatine had a statistically significant SMD of - 0.24 (-0.39 to -0.09) and response rate of (1.25, 1.07-1.47). In comparison (RR 0.99, 0.92-1.07) Agomelatine is an effective antidepressant having similar efficacy with the currently used antidepressants.
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Affiliation(s)
| | - Chava Hema
- Chebrolu Hanumaiah Institute of Pharmaceutical Sciences, Guntur, Andhra Pradesh, India.
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Gyorik D, Eszlari N, Gal Z, Torok D, Baksa D, Kristof Z, Sutori S, Petschner P, Juhasz G, Bagdy G, Gonda X. Every Night and Every Morn: Effect of Variation in CLOCK Gene on Depression Depends on Exposure to Early and Recent Stress. Front Psychiatry 2021; 12:687487. [PMID: 34512413 PMCID: PMC8428175 DOI: 10.3389/fpsyt.2021.687487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
The role of circadian dysregulation is increasingly acknowledged in the background of depressive symptoms, and is also a promising treatment target. Similarly, stress shows a complex relationship with the circadian system. The CLOCK gene, encoding a key element in circadian regulation has been implicated in previous candidate variant studies in depression with contradictory findings, and only a few such studies considered the interacting effects of stress. We investigated the effect of CLOCK variation with a linkage-disequilibrium-based clumping method, in interaction with childhood adversities and recent negative life events, on two phenotypes of depression, lifetime depression and current depressive symptoms in a general population sample. Methods: Participants in NewMood study completed questionnaires assessing childhood adversities and recent negative life events, the Brief Symptom Inventory to assess current depressive symptoms, provided data on lifetime depression, and were genotyped for 1054 SNPs in the CLOCK gene, 370 of which survived quality control and were entered into linear and logistic regression models with current depressive symptoms and lifetime depression as the outcome variable, and childhood adversities or recent life events as interaction variables followed by a linkage disequilibrium-based clumping process to identify clumps of SNPs with a significant main or interaction effect. Results: No significant clumps with a main effect were found. In interaction with recent life events a significant clump containing 94 SNPs with top SNP rs6825994 for dominant and rs6850524 for additive models on current depression was identified, while in interaction with childhood adversities on current depressive symptoms, two clumps, both containing 9 SNPs were found with top SNPs rs6828454 and rs711533. Conclusion: Our findings suggest that CLOCK contributes to depressive symptoms, but via mediating the effects of early adversities and recent stressors. Given the increasing burden on circadian rhythmicity in the modern lifestyle and our expanding insight into the contribution of circadian disruption in depression especially as a possible mediator of stress, our results may pave the way for identifying those who would be at an increased risk for depressogenic effects of circadian dysregulation in association with stress as well as new molecular targets for intervention in stress-related psychopathologies in mood disorders.
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Affiliation(s)
- Dorka Gyorik
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Nora Eszlari
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Zsofia Gal
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Dora Torok
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Daniel Baksa
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE-NAP-2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Zsuliet Kristof
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
- Laboratory of Molecular Pharmacology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Sara Sutori
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Peter Petschner
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhasz
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- SE-NAP-2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gyorgy Bagdy
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
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7
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Rojas M, Chávez-Castillo M, Pírela D, Ortega Á, Salazar J, Cano C, Chacín M, Riaño M, Batista MJ, Díaz EA, Rojas-Quintero J, Bermúdez V. Chronobiology and Chronotherapy in Depression: Current Knowledge and Chronotherapeutic Promises. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082216999201124152432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Depression is a heavily prevalent mental disorder. Symptoms of depression
extend beyond mood, cognition, and behavior to include a spectrum of somatic manifestations in all
organic systems. Changes in sleep and neuroendocrine rhythms are especially prominent, and disruptions
of circadian rhythms have been closely related to the neurobiology of depression. With the
advent of increased research in chronobiology, various pathophysiologic mechanisms have been
proposed, including anomalies of sleep architecture, the effects of clock gene polymorphisms in
monoamine metabolism, and the deleterious impact of social zeitgebers. The identification of these
chronodisruptions has propelled the emergence of several chronotherapeutic strategies, both pharmacological
and non-pharmacological, with varying degrees of clinical evidence.
Methods:
The fundamental objective of this review is to integrate current knowledge about the role
of chronobiology and depression and to summarize the interventions developed to resynchronize
biorhythms both within an individual and with geophysical time.
Results:
We have found that among the non-pharmacological alternatives, triple chronotherapywhich
encompasses bright light therapy, sleep deprivation therapy, and consecutive sleep phase
advance therapy-has garnered the most considerable scientific interest. On the other hand,
agomelatine appears to be the most promising pharmacological option, given its unique melatonergic
pharmacodynamics.
Conclusions:
Research in chronotherapy as a treatment for depression is currently booming. Novel
interventions could play a significant role in adopting new options for the treatment of depression,
with Tripe Cronotherapy standing out as the most promising treatment.
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Affiliation(s)
- Milagros Rojas
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Mervin Chávez-Castillo
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Daniela Pírela
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Ángel Ortega
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Juan Salazar
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Clímaco Cano
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Maricarmen Chacín
- Universidad Simon Bolivar, Facultad de Ciencias de la Salud, Barranquilla, Colombia
| | - Manuel Riaño
- Universidad Simon Bolívar, Facultad de Ciencias Juridicas y Sociales, Cucuta, Colombia
| | - María Judith Batista
- Universidad Simon Bolívar, Facultad de Ciencias Juridicas y Sociales, Cucuta, Colombia
| | - Edgar Alexis Díaz
- Universidad Simon Bolívar, Facultad de Ciencias Juridicas y Sociales, Cucuta, Colombia
| | - Joselyn Rojas-Quintero
- Pulmonary and Critical Care Medicine Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Valmore Bermúdez
- Universidad Simon Bolivar, Facultad de Ciencias de la Salud, Barranquilla, Colombia
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Maslej MM, Furukawa TA, Cipriani A, Andrews PW, Mulsant BH. Individual Differences in Response to Antidepressants: A Meta-analysis of Placebo-Controlled Randomized Clinical Trials. JAMA Psychiatry 2020; 77:607-617. [PMID: 32074273 PMCID: PMC7042922 DOI: 10.1001/jamapsychiatry.2019.4815] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Antidepressants are commonly used worldwide to treat major depressive disorder. Symptomatic response to antidepressants can vary depending on differences between individuals; however, this variability may reflect nonspecific or random factors. OBJECTIVES To investigate the assumption of systematic variability in symptomatic response to antidepressants and to assess whether this variability is associated with severity of major depressive disorder, antidepressant class, or year of study publication. DATA SOURCES Data used were from a recent network meta-analysis of acute treatment with licensed antidepressants in adults with major depressive disorder. The following databases were searched from inception to January 8, 2016: the Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, and PsycINFO. Additional sources were international trial registries, drug approval agency websites, and key scientific journals. STUDY SELECTION Analysis was restricted to double-blind, randomized placebo-controlled trials with available data at the study's end point. DATA EXTRACTION AND SYNTHESIS Baseline and end point means, SDs, number of participants in each group, antidepressant class, and publication year were extracted. The data were analyzed between August 14 and November 18, 2019. MAIN OUTCOMES AND MEASURES With the use of validated methods, coefficients of variation were derived for antidepressants and placebo, and their ratios were calculated to compare outcome variability between antidepressant and placebo. Ratios were entered into a random-effects model, with the expectation that response to antidepressants would be more variable than response to placebo. Analysis was repeated after stratifying by baseline severity of depression, antidepressant class (selective serotonin reuptake inhibitors: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and vilazodone; serotonin and norepinephrine reuptake inhibitors: desvenlafaxine and venlafaxine; norepinephrine-dopamine reuptake inhibitor: bupropion; noradrenergic agents: amitriptyline and reboxetine; and other antidepressants: agomelatine, mirtazapine, and trazodone), and publication year. RESULTS In the 87 eligible randomized placebo-controlled trials (17 540 unique participants), there was significantly more variability in response to antidepressants than to placebo (coefficients of variation ratio, 1.14; 95% CI, 1.11-1.17; P < .001). Baseline severity of depression did not moderate variability in response to antidepressants. Variability in response to selective serotonin reuptake inhibitors was lower than variability in response to noradrenergic agents (coefficients of variation ratio, 0.88; 95% CI, 0.80-0.97; P = .01), as was the variability in response to other antidepressants compared with noradrenergic agents (coefficients of variation ratio, 0.87; 95% CI, 0.79-0.97; P = .001). Variability also tended to be lower in studies that were published more recently, with coefficients of variation changing by a value of 0.005 (95% CI, 0.002-0.008; P = .003) for every year a study is more recent. CONCLUSIONS AND RELEVANCE Individual differences may be systematically associated with responses to antidepressants in major depressive disorder beyond placebo effects or statistical factors. This study provides empirical support for identifying moderators and personalizing antidepressant treatment.
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Affiliation(s)
- Marta M. Maslej
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Toshiaki A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Yoshida-Konoe, Sakyo, Kyoto, Japan,Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto University School of Public Health, Yoshida-Konoe, Sakyo, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom,Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
| | - Paul W. Andrews
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Duloxetine-Induced Hyponatremia in an Elderly Male Patient with Treatment-Refractory Major Depressive Disorder. Case Rep Psychiatry 2019; 2019:4109150. [PMID: 31214374 PMCID: PMC6535824 DOI: 10.1155/2019/4109150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/12/2019] [Accepted: 04/28/2019] [Indexed: 01/22/2023] Open
Abstract
Several classes of antidepressants can induce syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), thereby causing hyponatremia. Initial symptoms of hyponatremia include neuropsychiatric and gastrointestinal manifestations can mimic depression, especially in elderly people with multiple somatic complaints. Here we present a case of a 68-year-old man with treatment-refractory depression and general anxiety disorder who developed duloxetine-induced hyponatremia. His symptoms of hyponatremia including unsteady gait, dizziness, nausea, general malaise, and poor appetite subsided after discontinuing the offending medication. Our case illustrates that drug-induced SIADH and potential drug-drug interactions should be considered in elderly patients who develop hyponatremia following the initiation of antidepressants.
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10
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Villas Boas GR, Boerngen de Lacerda R, Paes MM, Gubert P, Almeida WLDC, Rescia VC, de Carvalho PMG, de Carvalho AAV, Oesterreich SA. Molecular aspects of depression: A review from neurobiology to treatment. Eur J Pharmacol 2019; 851:99-121. [PMID: 30776369 DOI: 10.1016/j.ejphar.2019.02.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Major depressive disorder (MDD), also known as unipolar depression, is one of the leading causes of disability and disease worldwide. The signs and symptoms are low self‑esteem, anhedonia, feeling of worthlessness, sense of rejection and guilt, suicidal thoughts, among others. This review focuses on studies with molecular-based approaches involving MDD to obtain an integrated, more detailed and comprehensive view of the brain changes produced by this disorder and its treatment and how the Central Nervous System (CNS) produces neuroplasticity to orchestrate adaptive defensive behaviors. This article integrates affective neuroscience, psychopharmacology, neuroanatomy and molecular biology data. In addition, there are two problems with current MDD treatments, namely: 1) Low rates of responsiveness to antidepressants and too slow onset of therapeutic effect; 2) Increased stress vulnerability and autonomy, which reduces the responses of currently available treatments. In the present review, we encourage the prospection of new bioactive agents for the development of treatments with post-transduction mechanisms, neurogenesis and pharmacogenetics inducers that bring greater benefits, with reduced risks and maximized access to patients, stimulating the field of research on mood disorders in order to use the potential of preclinical studies. For this purpose, improved animal models that incorporate the molecular and anatomical tools currently available can be applied. Besides, we encourage the study of drugs that do not present "classical application" as antidepressants, (e.g., the dissociative anesthetic ketamine and dextromethorphan) and drugs that have dual action mechanisms since they represent potential targets for novel drug development more useful for the treatment of MDD.
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Affiliation(s)
- Gustavo Roberto Villas Boas
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil; Faculty of Health Sciences, Federal University of Grande Dourados, Dourados Rodovia Dourados, Itahum Km 12, Cidade Universitaria, Caixa. postal 364, CEP 79804-970, Dourados, Mato Grosso do Sul, Brazil.
| | - Roseli Boerngen de Lacerda
- Department of Pharmacology of the Biological Sciences Center, Federal University of Paraná, Jardim das Américas, Caixa. postal 19031, CEP 81531-990, Curitiba, Paraná, Brazil.
| | - Marina Meirelles Paes
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Priscila Gubert
- Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Wagner Luis da Cruz Almeida
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Vanessa Cristina Rescia
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Pablinny Moreira Galdino de Carvalho
- Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Adryano Augustto Valladao de Carvalho
- Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Silvia Aparecida Oesterreich
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados Rodovia Dourados, Itahum Km 12, Cidade Universitaria, Caixa. postal 364, CEP 79804-970, Dourados, Mato Grosso do Sul, Brazil.
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Abstract
INTRODUCTION Agomelatine is an antidepressant with unique pharmacological actions; it is both a melatonin agonist and selective serotonin antagonist. Both actions combined are necessary for antidepressant efficacy. Effects on melatonin receptors enable resynchronisation of disrupted circadian rhythms with beneficial effects on sleep patterns. Areas covered: The issue of use of an antidepressant for depression co-morbid with somatic disorders is covered by the authors. A review of the literature from 2000 to August 2018 was undertaken using Scopus and Web of Science with the key words: agomelatine, depression, medical illness. Depression in Parkinson's disease, cardiovascular illness and type II diabetes is reviewed with evidence of efficacy. Bipolar depression and seasonal affective disorder may also react favourably. Agomelatine may have specific efficacy on symptoms of anhedonia. Expert opinion: Despite approval in some major jurisdictions, the drug has failed to gain registration in the United States. A defining issue may be questions about longer term efficacy: unequivocal effectiveness in placebo-controlled relapse prevention studies has not always been demonstrated. Continuation studies suggest maintenance of clinical responsiveness. A major disadvantage of the drug is its' potential hepatotoxicity and the need for repeated clinical laboratory tests.
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Affiliation(s)
- Trevor R Norman
- a Department of Psychiatry , University of Melbourne, Austin Hospital , Heidelberg , Australia
| | - James S Olver
- a Department of Psychiatry , University of Melbourne, Austin Hospital , Heidelberg , Australia
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Biological Rhythms Advance in Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:117-133. [DOI: 10.1007/978-981-32-9271-0_6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Ma HY, Liu ZF, Xu YF, Hu XD, Sun N, Li XR, Zhang KR. The association study of CLOCK gene polymorphisms with antidepressant effect in Chinese with major depressive disorder. Per Med 2018; 16:115-122. [PMID: 30569826 DOI: 10.2217/pme-2018-0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM Major depressive disorder (MDD) is a common psychiatric disorder with a complicated pathogenesis and genetic predisposition. The objective of this article is to explore the relationship between the four SNPs of circadian locomotor output cycles kaput (CLOCK) gene (rs11932595, rs12504300, rs3805148, rs534654) and the efficacy of antidepressants. Materials & methods: This study enrolled a total of 600 patients, who met the DSM-V diagnostic criteria for MDD. All subjects were treated with single selective serotonin reuptake inhibitors. The HAMD17 and adverse reaction scale (TESS/UKU) were used to assess the efficacy of antidepressants and adverse effects. The PCR and DNA sequencing analysis were used to genotype loci of CLOCK gene. RESULTS The antidepressants efficacy of subjects with rs11932595 AA genotype was significantly higher than those with GG+GA genotypes (p = 0.035). But this p-value was not significant after false discovery rate (FDR) adjustment. CONCLUSION The variant of CLOCK gene may be associated with the efficacy of selective serotonin reuptake inhibitors in Chinese Han MDD patients.
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Affiliation(s)
- Hui-Ying Ma
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan 030000, People's Republic of China
| | - Zhi-Fen Liu
- The First Hospital of Shanxi Medical University in South Jiefang Road, Taiyuan, Shanxi Province, People's Republic of China
| | - Yi-Fan Xu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan 030000, People's Republic of China
| | - Xiao-Dong Hu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan 030000, People's Republic of China
| | - Ning Sun
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan 030000, People's Republic of China
| | - Xin-Rong Li
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan 030000, People's Republic of China
| | - Ke-Rang Zhang
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan 030000, People's Republic of China
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Efficacy and Safety of Agomelatine vs Paroxetine Hydrochloride in Chinese Han Patients with Major Depressive Disorder: A Multicentre, Double-Blind, Noninferiority, Randomized Controlled Trial. J Clin Psychopharmacol 2018; 38:226-233. [PMID: 29620692 DOI: 10.1097/jcp.0000000000000878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to investigate the efficacy, safety, and tolerability of agomelatine and paroxetine in Chinese Han patients with major depressive disorder (MDD). METHODS A 8-week, double-blind, randomized, parallel study was conducted in 14 medical centers in mainland China from December 2011 to September 2012. A total of 264 subjects with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD were randomly assigned to receive agomelatine 25-50 mg/d (n = 132) or paroxetine 20-40 mg/d (n = 132). The primary efficacy was evaluated by the decrease of Hamilton Depression Rating Scale (HAM-D17) scores. The secondary measurements of efficacy included Hamilton Anxiety Rating Scale, Montgomery-Asberg Depression Rating Scale, Sheehan Disability Scale, Clinical Global Impressions-Severity, and Clinical Global Impressions-Improvement. The laboratory test abnormity, and observed and self-reported adverse events were all assessed as the measurements of safety and tolerability. RESULTS Both the agomelatine and paroxetine groups showed significant improvement from baseline to the end point (P < 0.05) without between-group differences (P > 0.05). The mean decrease of HAM-D17 of agomelatine group was not inferior to the paroxetine group over the 8-week treatment (agomelatine 15.26 ± 6.44 vs paroxetine 14.87 ± 5.89, δ = 2.0; μA-μB 95% confidence interval, -1.13 to 1.91). The percentage of responders at the last postbaseline assessment was similar in the 2 groups on both HAM-D17 (agomelatine 66.15% vs paroxetine 63.49%) and Clinical Global Impressions-Improvement (agomelatine 79.09% vs paroxetine 80.36%). The anxiety (Hamilton Anxiety Rating Scale) and sleep symptoms (sleep items of HAM-D17) of the patients were improved significantly in the 2 groups at week 8 without between-group differences (P > 0.05). The incidence of overall adverse events was similar in the 2 groups (agomelatine 49.62% vs paroxetine 56.15%, P > 0.05). The incidence of adverse events in skin and subcutaneous tissue was higher in the paroxetine group than in the agomelatine group (none in agomelatine and 4.62% in paroxetine, P = 0.0144). CONCLUSIONS Agomelatine showed equivalent antidepressant efficacy to paroxetine in treating MDD patients after 8 weeks of treatment with an acceptable safety.
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15
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Abstract
SummaryAgomelatine is a new antidepressant, licensed for the treatment of unipolar major depression, with a mode of action that combines activation of melatonin receptors with blockade of 5-HT2C receptors. Agomelatine is notable for its short duration of action in the body and modest side-effect burden; however, a number of theoretical and practical challenges have limited its adoption into mainstream treatment in the UK. Current meta-analyses show marginal clinical benefits of agomelatine relative to placebo and an association with occasional increases in liver transaminases. Theoretically it is not clear whether agomelatine does block brain 5-HT2C receptors in humans at therapeutic doses and the optimum daily timing of administration in depression has not been clearly established. However, agomelatine's novel mode of action justifies further study, perhaps with the eventual aim of matching its use in depression to patients with specific disturbances in circadian rhythm.
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Kennedy SH, Grouin JM, Cadour S, Robert V, Picarel-Blanchot F. Relative short-term efficacy and acceptability of agomelatine versus vortioxetine in adult patients suffering from major depressive disorder. Hum Psychopharmacol 2018; 33. [PMID: 29327372 DOI: 10.1002/hup.2646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/02/2017] [Accepted: 11/21/2017] [Indexed: 11/08/2022]
Abstract
Agomelatine and vortioxetine are antidepressants with different mechanisms of action compared to other pharmaceutical treatment options. The objective of this present analysis is to determine the relative efficacy and acceptability of agomelatine (25-50 mg) compared to vortioxetine (10-15-20 mg) in adult patients with major depressive disorder. We performed an adjusted indirect comparison using placebo as a common control. The main outcomes were efficacy (response to treatment by Montgomery-Åsberg depression rating scale/Hamilton Rating Scale for Depression) and acceptability (withdrawal rate for any reason or due to adverse events). 10 agomelatine and 11 vortioxetine studies were included in the analysis. For efficacy, no difference was shown between agomelatine and vortioxetine (E[95% CI] = -0.03 [-0.12;0.05]). For acceptability, no significant difference was found between both antidepressants. These findings substantiate current understanding that most antidepressants are of similar average efficacy and tolerability. Such equivalent therapeutic benefit of both compounds, measured by a quantitative clinical research approach, has to be discussed with the knowledge of a qualitative estimation in routine practice.
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Affiliation(s)
- Sidney H Kennedy
- University of Toronto, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | | | - Stéphanie Cadour
- Biostatistics Department and Neuropsychiatry Center for Therapeutic Innovation, Institut de Recherches Internationales Servier (IRIS), Suresnes, France
| | - Véronique Robert
- Biostatistics Department and Neuropsychiatry Center for Therapeutic Innovation, Institut de Recherches Internationales Servier (IRIS), Suresnes, France
| | - Françoise Picarel-Blanchot
- Biostatistics Department and Neuropsychiatry Center for Therapeutic Innovation, Institut de Recherches Internationales Servier (IRIS), Suresnes, France
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Martin V, Riffaud A, Marday T, Brouillard C, Franc B, Tassin JP, Sevoz-Couche C, Mongeau R, Lanfumey L. Response of Htr3a knockout mice to antidepressant treatment and chronic stress. Br J Pharmacol 2017; 174:2471-2483. [PMID: 28493335 DOI: 10.1111/bph.13857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE It has recently been suggested that 5-HT3 receptor blockade enhances the efficacy of selective 5-HT (serotonin) reuptake inhibitor (SSRI) antidepressants and may reverse stress-induced deficits in rodents. EXPERIMENTAL APPROACH To further explore this hypothesis, we used mice lacking the 5-HT3 receptor (Htr3a KO) and their wild-type (WT) controls to assess their response in behavioural paradigms relevant to anxiety and depression. Mice were studied under basal, antidepressant treatments and chronic social defeat stress (CSDS) conditions. KEY RESULTS In basal conditions, Htr3a KO mice displayed anxiolytic- and antidepressant-like behaviours in the elevated plus maze, the social interaction and the forced swim tests (FST), but behaved as WT mice in response to acute citalopram in the FST. However, the effects of fluoxetine were blunted in Htr3a KO mice in these same tests. In an in vitro electrophysiological paradigm, a low-dose citalopram treatment triggered 5-HT1A receptor desensitization only in the dorsal raphe nucleus of Htr3a KO, although a high dose desensitized 5-HT1A autoreceptor function equally in Htr3a KO and WT mice, suggesting that citalopram may become effective at lower doses when 5-HT3 receptors are inactivated. In addition, Htr3a deletion blocked CSDS-induced modification in the cortical expression of two genes involved in oxidative stress, CaMKIIa and SOD1. CONCLUSIONS AND IMPLICATIONS Taken together, these data show that Htr3a deletion promotes SSRI efficacy and prevents the occurrence of stress-induced deleterious effects, suggesting that the 5-HT3 receptor may represent an interesting target for the treatment of stress-related disorders.
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Affiliation(s)
- Vincent Martin
- Inserm UMR S894, Centre de Psychiatrie et Neuroscience, Université Paris Descartes, Paris, France
| | - Armance Riffaud
- Inserm UMR S894, Centre de Psychiatrie et Neuroscience, Université Paris Descartes, Paris, France
| | - Tevrasamy Marday
- Inserm UMR S894, Centre de Psychiatrie et Neuroscience, Université Paris Descartes, Paris, France
| | - Charly Brouillard
- Inserm UMR S1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie, Paris, France
| | - Bernard Franc
- Inserm UMR S894, Centre de Psychiatrie et Neuroscience, Université Paris Descartes, Paris, France
| | - Jean-Pol Tassin
- Inserm UMR S1130, Neurosciences Paris Seine, Université Pierre et Marie Curie, Paris, France
| | - Caroline Sevoz-Couche
- Inserm UMR S1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie, Paris, France
| | - Raymond Mongeau
- EA 4475, Pharmacologie de la circulation cérébrale, Université Paris Descartes, Paris, France
| | - Laurence Lanfumey
- Inserm UMR S894, Centre de Psychiatrie et Neuroscience, Université Paris Descartes, Paris, France
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Laux G, Barthel B, Hajak G, Lemke M, Volz HP. Pooled Analysis of Four Non-Interventional Studies: Effectiveness and Tolerability of the Antidepressant Agomelatine in Daily Practice. Adv Ther 2017; 34:895-914. [PMID: 28214983 DOI: 10.1007/s12325-017-0485-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Meta-analyses are useful to increase knowledge and strengthen evidence about antidepressant treatment supplementary to individual studies. METHODS A pooled analysis of four multicenter, open-label, prospective, non-interventional studies (2009-2013) was performed to provide further evidence about the antidepressant effectiveness and tolerability of agomelatine (25-50 mg/day) in a large number of non-selected German outpatients with major depressive disorder. The main analysis was performed after 12 weeks (n = 9601) and in subpopulations after 24 and 52 weeks by descriptive statistical methods. RESULTS Overall, 60.1% of patients were pretreated with antidepressants. Concomitant psychiatric diseases (71.9%), co-medication with antidepressants (18.9%) and/or psychotropic medication (31.9%) were observed. Depressive symptoms improved according to the Clinical Global Impression (CGI) in 81% after 12 weeks, a response was observed in 78.7% (CGI-I ≤2), and remission in 34.5% of patients (CGI-S = 1 or 2). In subpopulations, response was documented in 79.3% (W24) and 75.9% (W52) and remission in 38.1% (W24) and 47.5% (W52), respectively. Over 12 weeks, adverse drug reactions (ADRs) were reported for 511 patients (5.32%), most frequently headache (0.92%) and nausea (0.75%), and serious adverse drug reactions (sADR) for 18 patients (0.19%). Between W12-W24 and W24-W52, ADRs were reported for 0.49%/0.99% and sADRs for 0.05%/0%, respectively. Overall, 49 patients (0.5%) showed clinically relevant transaminase elevations (AST/ALT >3 times upper normal value), with 19 patients (0.2%) showing preexisting elevations at the study start. One patient (0.03%) developed hepatitis with reversible symptoms after treatment discontinuation. ADR predominantly occurred within the first weeks of treatment. Mean weight and body mass index (BMI) remained unchanged over 24 weeks. CONCLUSION In this pooled data analysis, 9601 depressed patients of clinical practice were evaluated over 12 weeks and subpopulations were also analyzed over 24 and 52 weeks. Agomelatine effectively reduced depressive symptoms (CGI-response and remission) with good general tolerability.
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Florea I, Loft H, Danchenko N, Rive B, Brignone M, Merikle E, Jacobsen PL, Sheehan DV. The effect of vortioxetine on overall patient functioning in patients with major depressive disorder. Brain Behav 2017; 7:e00622. [PMID: 28293465 PMCID: PMC5346512 DOI: 10.1002/brb3.622] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/05/2016] [Accepted: 11/09/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The objectives of this meta-analysis of data from randomized, placebo-controlled studies were to assess the effect of vortioxetine on overall functioning (primary) and functional remission (secondary) using the Sheehan Disability Scale (SDS) in adults with major depressive disorder (MDD). METHODS Data from nine short-term (6/8 weeks) pivotal studies that included patient functioning assessments were included in this random-effects meta-analysis, which used aggregated study-level data for all therapeutic vortioxetine doses and a mixed-effect model for repeated measures using the full analysis set. RESULTS A total of 4,216 patients received ≥1 dose of study treatment (1,522 placebo, 2,694 vortioxetine 5-20 mg/day). At study end, the meta-analysis showed improvement for vortioxetine versus placebo (n = 911) in SDS total score (vortioxetine 5 mg, n = 564, change from baseline versus placebo [Δ] -0.24, p = NS; 10 mg, n = 445, Δ -1.68, p ≤ .001; 15 mg, n = 204, Δ -0.91, p = NS; 20 mg, n = 340, Δ -1.94, p ≤ .01). Functional remission (SDS total score ≤6) was observed with vortioxetine 10 mg (n = 170/573; odds ratio [OR] relative to placebo 1.7, p < .001) and 20 mg (n = 144/447; OR 1.6, p < .05), but not 5 mg (n = 207/757; OR 1.1, p = NS) or 15 mg (n = 92/295; OR 1.3, p = NS). CONCLUSION Vortioxetine 5-20 mg for 6/8 weeks improved overall patient functioning in patients with MDD. Relative to placebo, vortioxetine 10 and 20 mg demonstrated significant improvement in SDS total score and functional remission.
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Affiliation(s)
| | | | | | | | | | | | | | - David V Sheehan
- University of South Florida College of Medicine Tampa FL USA
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20
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Using Placebo Response to Pain as a Predictor of Placebo Response in Mood Disorders. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Perlemuter G, Cacoub P, Valla D, Guyader D, Saba B, Batailler C, Moore K. Characterisation of Agomelatine-Induced Increase in Liver Enzymes: Frequency and Risk Factors Determined from a Pooled Analysis of 7605 Treated Patients. CNS Drugs 2016; 30:877-88. [PMID: 27342740 DOI: 10.1007/s40263-016-0351-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Antidepressant-induced liver injury is a major concern and a liver monitoring scheme has been recommended by the European Medicines Agency for agomelatine. OBJECTIVE The objective of this study was to assess the liver safety and identify the characteristics of patients who developed a significant increase in transaminases whilst taking agomelatine. METHOD A retrospective pooled analysis of changes in transaminase levels in 9234 patients treated with agomelatine (25 or 50 mg/day; n = 7605) or placebo (n = 1629) from 49 phase II and III studies was undertaken. A significant increase in transaminase levels was defined as an increase to >3 times the upper limit of normal (ULN) (>3 × ULN). Final causality was determined in a case-by-case review by five academic experts. RESULTS Serum transaminases increased to >3 × ULN in 1.3 and 2.5 % of patients treated with 25 and 50 mg of agomelatine, respectively, compared with 0.5 % for placebo. The onset of increased transaminases occurred before 12 weeks in 64 % of patients. The median time to recovery (to ≤2 × ULN) was 14 days following treatment withdrawal. Liver function tests recovered in 36.1 % of patients despite continuation of agomelatine, suggesting the presence of a liver adaptive mechanism. No cases of acute liver failure or fatal outcome occurred. Patients with elevated transaminases at baseline, secondary to obesity/fatty liver disease, had an equally increased risk of developing further elevations of transaminases with agomelatine and placebo. CONCLUSION Incidence of abnormal transaminases was low and dose dependent. No specific population was identified regarding potential risk factors. Withdrawal of agomelatine led to rapid recovery, and some patients exhibited an adaptive phenomenon. Overall, in clinical trials, the liver profile of agomelatine seems safe when serum transaminases are monitored.
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Affiliation(s)
- Gabriel Perlemuter
- Univ. Paris-Sud, Univ. Paris-Saclay, CHU Bicêtre, 94270, Kremlin-Bicêtre, France. .,AP-HP, Hôpital Antoine-Béclère, Service d'Hépato-Gastroentérologie et Nutrition, DHU Hepatinov, 157 rue de la Porte de Trivaux, 92140, Clamart, France. .,INSERM U996, IPSIT, Labex Lermit, Clamart, France.
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DHU i2B), 75005, Paris, France.,INSERM, UMR_S 959, 75013, Paris, France.,CNRS, FRE3632, 75005, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Dominique Valla
- DHU UNITY, Service d'Hépatologie, AP-HP, Hôpital Beaujon, Clichy, France.,CRI, UMR1149, Université Paris Diderot, Paris, France.,INSERM U1149, Paris, France
| | - Dominique Guyader
- Liver Disease Unit and INSERM U991, CHU Pontchaillou, Rennes, France.,University of Rennes 1, CHU de Rennes, Rennes, France
| | - Barbara Saba
- Institut de Recherches Internationales Servier, 92415, Suresnes, France
| | - Cécile Batailler
- Institut de Recherches Internationales Servier, 92415, Suresnes, France
| | - Kevin Moore
- UCL Institute of Liver and Digestive Health, University College London, Royal Free Campus, London, UK
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Evans VC, Alamian G, McLeod J, Woo C, Yatham LN, Lam RW. The Effects of Newer Antidepressants on Occupational Impairment in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. CNS Drugs 2016; 30:405-17. [PMID: 27113464 DOI: 10.1007/s40263-016-0334-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES A substantial proportion of the disease burden of major depressive disorder (MDD) results from impairments in occupational functioning, including disability and reduced productivity. Accumulating evidence suggests that antidepressants can improve functional as well as symptomatic outcomes in patients with MDD. We examined the treatment effects of newer antidepressants on occupational impairment in MDD, based on a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We searched MEDLINE, EMBASE, and ClinicalTrials.gov for the period 1 January 1992 to 15 June 2015 to identify RCTs of newer antidepressants (excluding tricyclic antidepressants and monoamine oxidase inhibitors), with or without a placebo condition, that included a validated measure of occupational functioning in patients with MDD. Abstracts were scanned for eligibility by two independent reviewers and investigators of unpublished studies were contacted to obtain data. Study data were extracted and double-entered for accuracy. We selected the Sheehan Disability Scale Work/School subscale (SDS-Work) for the meta-analysis because it was the most consistently used assessment of occupational impairment. Analysis employed a random-effects model. RESULTS The systematic review initially identified 42 RCTs but only 28 (67 %) had data on occupational outcomes that were published or obtained from investigators. The SDS-Work subscale was used in 25 of 28 trials; five other assessments of occupational functioning were used in seven trials. Data were synthesized from 17 placebo-controlled studies (n = 7031) that used the SDS-Work subscale. Antidepressants (n = 4722) were significantly superior to placebo (n = 2309) in improving SDS-Work scores at 8 weeks, with a mean difference of 0.73 [95 % confidence interval (CI) 0.60-0.86] and a standardized mean difference of 0.28 (95 % CI 0.23-0.33), representing small effects. LIMITATIONS Few included trials reported on the employment status of their samples, and most trials were of short-term treatment duration (8-12 weeks). Several RCTs that collected data on occupational outcomes were also excluded from the review and meta-analysis because their data were unpublished and unobtainable. CONCLUSIONS Our meta-analysis suggests that newer antidepressants have a small, positive impact on occupational impairment in the short-term, but the clinical significance of this impact is questionable. To improve assessment of this important outcome, future research studies should use more comprehensive measures of occupational functioning, productivity and impairment, and longer treatment durations.
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Affiliation(s)
- Vanessa C Evans
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Golnoush Alamian
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Jane McLeod
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Cindy Woo
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
- Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada.
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Agomelatine for Depression in Parkinson Disease: Additional Effect on Sleep and Motor Dysfunction. J Clin Psychopharmacol 2015; 35:719-23. [PMID: 26444951 DOI: 10.1097/jcp.0000000000000404] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression and sleep disorders are among the most prevalent nonmotor symptoms of Parkinson disease (PD). Because agomelatine acts as a MT1 and MT2 agonist and as a 5HT2c antagonist, this study was designed to assess the efficacy of agomelatine in treating depressive symptoms in PD patients, and the potential changes both in sleep quality and motor symptoms. Depressed patients with PD were treated with agomelatine for 6 months, and they were evaluated with an array of scales. Completed nocturnal video-polysomnography was performed at baseline and week 12. The efficacy analysis population included 24 patients (12 men). The mean (SD) age was 75.2 (8.3) years. The mean (SD) daily dose of agomelatine was 25.00 (10.43) mg at 24 weeks. No changes in dopamine replacement therapy were made. There was a significant decrease in the 17-item Hamilton Depression Scale score over the course of the study (P < 0.0005). The Scales for Outcomes in Parkinson disease Sleep Questionnaire showed a statistically significant improvement over time in each of its subscales: nighttime sleep (P < 0.005), last month nighttime sleep (P < 0.0005), and daytime sleepiness (P < 0.0005). Surprisingly, changes over time in the motor subscale of Unified Parkinson Disease Rating Scale were statistically significant (P < 0.0005). Periodic limb movements and awakenings measured by polysomnography improved significantly (P < 0.005 and P < 0.05, respectively). We concluded that the use of agomelatine in PD depressed patients may have a considerable therapeutic potential because of its dual action for treating both symptoms of depression and disturbed sleep given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms.
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Effects of long-term agomelatine treatment on the cognitive performance and hippocampal plasticity of adult rats. Behav Pharmacol 2015; 26:469-80. [DOI: 10.1097/fbp.0000000000000153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Kim JM, Stewart R, Bae KY, Kang HJ, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Yoon JS. Correlates and Escitalopram Treatment Effects on Sleep Disturbance in Patients with Acute Coronary Syndrome: K-DEPACS and EsDEPACS. Sleep 2015; 38:1105-11. [PMID: 25581916 DOI: 10.5665/sleep.4822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 12/07/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To investigate the correlates of sleep disturbance and to assess escitalopram treatment effects of depression on sleep disturbance in patients with acute coronary syndrome (ACS). DESIGN A cross-sectional study in patients with ACS within 2 w post-ACS, and a 24-w double-blind controlled trial of escitalopram against placebo for patients with ACS who have comorbid depressive disorders. SETTING A university hospital in South Korea. PARTICIPANTS There were 1,152 patients with ACS who were consecutively recruited. Of 446 patients with comorbid depressive disorders, 300 were randomized to the trial. MEASUREMENTS AND RESULTS Sleep disturbance was evaluated by the Leeds Sleep Evaluation Questionnaire. Demographic and clinical characteristics were assessed, including cardiovascular risk factors, current cardiac status, and depressive symptoms. Depressive symptoms were most strongly and consistently associated with sleep disturbance. In addition, older age, female sex, hypertension, and more severe ACS status were associated with certain aspects of sleep disturbance. Escitalopram was significantly superior to placebo for improving sleep disturbance over the 24-w treatment period. These effects were substantially explained by improvement in depressive symptoms. CONCLUSIONS Depression screening is indicated in patients with acute coronary syndrome with sleep disturbance. Successful treatment of depression has beneficial effects on sleep outcomes in these patients. CLINICAL TRIALS INFORMATION ClinicalTrial.gov identifier for the 24-w drug trial, NCT00419471.
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Affiliation(s)
- Jae-Min Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | | | - Kyung-Yeol Bae
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Freiesleben SD, Furczyk K. A systematic review of agomelatine-induced liver injury. J Mol Psychiatry 2015; 3:4. [PMID: 25932327 PMCID: PMC4407422 DOI: 10.1186/s40303-015-0011-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 04/11/2015] [Indexed: 02/06/2023] Open
Abstract
Agomelatine is an antidepressant with a unique mechanism of action. Since its marketing in 2009, concerns have been raised regarding its potential to induce liver injury. The authors therefore address the need to comprehensively evaluate the potential risk posed by agomelatine of inducing liver injury by reviewing data from published and unpublished clinical trials in both the pre- and postmarketing settings, as well as data from non-interventional studies, pharmacovigilance database reviews and one case report. Recommendations for clinicians are also provided. In this review, agomelatine was found to be associated with higher rates of liver injury than both placebo and the four active comparator antidepressants used in the clinical trials for agomelatine, with rates as high as 4.6% for agomelatine compared to 2.1% for placebo, 1.4% for escitalopram, 0.6% for paroxetine, 0.4% for fluoxetine, and 0% for sertraline. The review also provides evidence for the existence of a positive relationship between agomelatine dose and liver injury. Furthermore, rates of liver injury were found to be lower in non-interventional studies. Findings from pharmacovigilance database reviews and one case report also highlight the risk of agomelatine-induced liver injury. As agomelatine does pose a risk of liver injury, clinicians must carefully monitor liver function throughout treatment. However, agomelatine’s unique mechanism of action and favourable safety profile render it a valuable treatment option. A quantitative analysis of agomelatine-induced liver injury is lacking in the literature and would be welcomed.
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Affiliation(s)
- Silka Dawn Freiesleben
- Department of Psychiatry, University of Rostock, Gehlsheimerstraße 20, 18147 Rostock, Germany
| | - Karolina Furczyk
- Department of Psychiatry, University of Rostock, Gehlsheimerstraße 20, 18147 Rostock, Germany
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Schatzberg AF. Issues encountered in recent attempts to develop novel antidepressant agents. Ann N Y Acad Sci 2015; 1345:67-73. [DOI: 10.1111/nyas.12716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alan F. Schatzberg
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford California
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Perugi G, Quaranta G, Bucci N. The use of agomelatine in OCD: effects on the motivational aspects and dysregulated circadian rhythms. Expert Opin Investig Drugs 2015; 24:705-13. [DOI: 10.1517/13543784.2015.1021918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pescosolido N, Gatto V, Stefanucci A, Rusciano D. Oral treatment with the melatonin agonist agomelatine lowers the intraocular pressure of glaucoma patients. Ophthalmic Physiol Opt 2015; 35:201-5. [DOI: 10.1111/opo.12189] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/29/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Nicola Pescosolido
- Facoltà di Medicina e Odontoiatria; Università di Roma La Sapienza; Rome Italy
| | - Vittorio Gatto
- Facoltà di Medicina e Odontoiatria; Università di Roma La Sapienza; Rome Italy
| | - Alessio Stefanucci
- Facoltà di Medicina e Odontoiatria; Università di Roma La Sapienza; Rome Italy
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Spielmans GI, Gerwig K. The efficacy of antidepressants on overall well-being and self-reported depression symptom severity in youth: a meta-analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:158-64. [PMID: 24732909 DOI: 10.1159/000356191] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent meta-analyses of the efficacy of second-generation antidepressants for youth have concluded that such drugs possess a statistically significant advantage over placebo in terms of clinician-rated depressive symptoms. However, no meta-analysis has included measures of quality of life, global mental health, self-esteem, or autonomy. Further, prior meta-analyses have not included self-reports of depressive symptoms. METHODS Studies were selected through searching Medline, PsycINFO, and the Cochrane Central Register for Controlled Trials databases as well as GlaxoSmithKline's online trial registry. We included self-reports of depressive symptoms and pooled measures of quality of life, global mental health, self-esteem, and autonomous functioning as a proxy for overall well-being. RESULTS We found a nonsignificant difference between second-generation antidepressants and placebo in terms of self-reported depressive symptoms (k = 6 trials, g = 0.06, p = 0.36). Further, pooled across measures of quality of life, global mental health, self-esteem, and autonomy, antidepressants yielded no significant advantage over placebo (k = 3 trials, g = 0.11, p = 0.13). DISCUSSION Though limited by a small number of trials, our analyses suggest that antidepressants offer little to no benefit in improving overall well-being among depressed children and adolescents.
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Affiliation(s)
- Glen I Spielmans
- Department of Psychology, Metropolitan State University, Saint Paul, Minn., USA
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Llorca PM, Lançon C, Brignone M, Rive B, Salah S, Ereshefsky L, Francois C. Relative efficacy and tolerability of vortioxetine versus selected antidepressants by indirect comparisons of similar clinical studies. Curr Med Res Opin 2014; 30:2589-606. [PMID: 25249164 DOI: 10.1185/03007995.2014.969566] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Vortioxetine is an antidepressant with multimodal activity which has shown efficacy in major depressive disorder (MDD) patients in six of ten short-term, randomized, placebo-controlled trials (completed end 2012). METHODS We performed meta-regression analyses to indirectly compare vortioxetine to seven marketed antidepressants with different mechanisms of action. To ensure study comparability, only experimental drug and placebo arms from placebo-controlled registration studies were included in primary analyses. The main outcomes were efficacy (standardized mean difference in change from baseline to 2 months on primary endpoint [MADRS/HAM-D]), and tolerability (withdrawal rate due to adverse events). RESULTS For efficacy, estimates of treatment effect (negative estimates favor vortioxetine) for vortioxetine versus comparators were: agomelatine, -0.16 (p = 0.11); desvenlafaxine, 0.03 (p = 0.80); duloxetine, 0.09 (p = 0.42); escitalopram, -0.05 (p = 0.70); sertraline, -0.04 (p = 0.83); venlafaxine IR/XR, 0.12 (p = 0.33); and vilazodone, -0.25 (p = 0.11). For tolerability, all but one combination was numerically in favor of vortioxetine (odds ratio < 1), although not all differences were statistically significant: agomelatine, 1.77 (p = 0.03); desvenlafaxine, 0.58 (p = 0.04); duloxetine, 0.75 (p = 0.26); escitalopram, 0.67 (p = 0.28); sertraline, 0.30 (p = 0.01); venlafaxine, 0.47 (p = 0.01); and vilazodone, 0.64 (p = 0.18). Sensitivity analyses did not significantly alter antidepressant effect estimates or relative ranking. CONCLUSION These meta-regression data show that vortioxetine offers a comparable or favorable combination of efficacy (measured by MADRS/HAM-D) and tolerability (measured by withdrawal rate due to adverse events) versus other antidepressants in registration studies in MDD. Alternative methods like mixed-treatment comparison and inclusion of all randomized studies and active reference arms may provide complementary information to this analysis (more evidence but also more heterogeneity). Key messages: Indirect comparisons based on registration studies allow a useful comparison between a recently approved antidepressant and an approved drug. Vortioxetine offers a comparable or favorable combination of efficacy (measured by MADRS/HAM-D assessments) and tolerability (measured by withdrawal rate due to adverse events) versus other antidepressants in registration studies in MDD.
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Gahr M. Agomelatine in the treatment of major depressive disorder: an assessment of benefits and risks. Curr Neuropharmacol 2014; 12:287-398. [PMID: 25426008 PMCID: PMC4243030 DOI: 10.2174/1570159x12999140619122914] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/29/2014] [Accepted: 06/01/2014] [Indexed: 12/13/2022] Open
Abstract
Agomelatine (AGM) was approved for the treatment of major depressive disorder (MDD) in adults by the European Medicines Agency (EMA) in February 2009. It is an analogue of melatonin and features a unique pharmacodynamic profile with agonism on both types of melatonergic receptors (MT1/MT2) and antagonism at serotonergic 5-HT2C receptors. There is, however, an ongoing debate regarding the efficacy and safety of this novel antidepressant agent, originally evoked by claims of a significant publication bias underlying the assessment of AGM being an effective antidepressant. Indeed, two recent comprehensive metaanalyses of published and unpublished clinical trials found evidence for a relevant publication bias. However, due to its statistically significant advantage over placebo based on the results of these metaanalyses AGM must be referred to as an effective antidepressant agent in the acute phase of MDD. However, the effect sizes of AGM in the treatment of MDD were evaluated as being small in comparison to other antidepressant agents. In addition, there is insufficient evidence for the efficacy of AGM in relapse prevention of MDD. Apart from efficacy issues, AGM appears to have the potential to exhibit severe hepatotoxicity (the EMA has identified AGM-associated “hepatotoxic reactions” as a new safety concern in September 2013) that is currently poorly understood. Considering these aspects, it seems inappropriate to evaluate AGM as an antidepressant agent of first choice. Nevertheless, its unique mechanism of action with particular sleep modulating effects may represent a specific treatment strategy for patients with particular characteristics; further studies with thorough characterization of patients are needed to test this hypothesis.
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Affiliation(s)
- Maximilian Gahr
- University of Ulm, Department of Psychiatry and Psychotherapy III. Leimgrubenweg 12-14, 89075 Ulm, Ulm, Germany
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Affiliation(s)
- K Outhoff
- Department of Pharmacology, University of Pretoria
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Huang KL, Lu WC, Wang YY, Hu GC, Lu CH, Lee WY, Hsu CC. Comparison of agomelatine and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors in major depressive disorder: A meta-analysis of head-to-head randomized clinical trials. Aust N Z J Psychiatry 2014; 48:663-71. [PMID: 24604920 DOI: 10.1177/0004867414525837] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Agomelatine is a new antidepressant with unique melatonin receptor type 1A (MTNR1A) and 1B ( MTNR1B) agonism and serotonergic receptor 5-hydroxytryptamine receptor 2C (5-HT-2C) antagonism. Several studies of patients with major depressive disorder (MDD) have confirmed the superior efficacy and safety of agomelatine in comparison with established treatments, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This meta-analysis comprehensively shows the efficacy, acceptability, and safety of agomelatine in comparison with SSRIs and SNRIs used as antidepressants in MDD. METHOD Comprehensive electronic database searches were performed to identify reports of head-to-head randomized controlled trials that have compared agomelatine with SSRIs or SNRIs in terms of efficacy/effectiveness in treating MDD. Response and remission rates at both acute (6-12 weeks) and follow-up (24 weeks) phases, Clinical Global Impression-Improvement Scale response and remission rates, changes in depression scale scores, improvements in subjective sleep, dropout rates, and side effect rates were extracted and analysed. RESULTS The meta-analysis included six head-to-head trials involving 1871 patients. In the acute phase, agomelatine had higher response rates (relative risk (RR) 1.08, 95% confidence interval (CI) 1.02-1.15) compared to SSRIs and SNRIs. In the remission analysis, only acute remission rates (RR 1.12, 95% CI 1.01-1.24) significantly differed. The action of agomelatine was superior on the Leeds Sleep Evaluation Questionnaire-Quality of Sleep score (mean difference 4.05, 95% CI 0.61-7.49). Discontinuation due to inefficacy did not differ between agomelatine and SSRIs/SNRIs (RR 0.74, 95% CI 0.42-1.28). Compared to SSRIs and SNRIs, however, agomelatine revealed a lower rate of discontinuation due to side effects (RR 0.38, 95% CI 0.25-0.57). CONCLUSIONS Agomelatine has significantly higher efficacy and potential acceptability compared to SSRIs and SNRIs when treating MDD. However, the difference in efficacy is not considered clinically relevant. Because of its unique chronobiotic effects, agomelatine may be useful for the management of some MDD patients with circadian disturbance.
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Affiliation(s)
- Kai-Lin Huang
- Department of Pharmacy, Mackay Memorial Hospital, Taiwan
| | - Wan-Chen Lu
- Department of Pharmacy, Mackay Memorial Hospital, Taiwan
| | - Ying-Yue Wang
- Department of Pharmacy, Mackay Memorial Hospital, Taiwan
| | - Gwo-Chi Hu
- Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taiwan
| | - Chien-Hung Lu
- Department of Pharmacy, Mackay Memorial Hospital, Taiwan
| | - Wei-Ying Lee
- Department of Pharmacy, Mackay Memorial Hospital, Taiwan
| | - Chien-Chi Hsu
- Department of Psychiatry, Mackay Memorial Hospital, Taiwan
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Laux G, Huttner NA. Subgroup analysis of the non-interventional study VIVALDI: agomelatine in treatment-naïve patients, in combination therapy and after treatment switch. Int J Psychiatry Clin Pract 2014; 18:86-96. [PMID: 24506342 DOI: 10.3109/13651501.2014.892138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Agomelatine has demonstrated antidepressant efficacy in randomized, controlled trials. This non-interventional study VIVALDI evaluated agomelatine treatment under practice conditions. METHODS Psychiatrists documented the treatment of 3,317 patients over 12 weeks. According to the treatment condition three subgroups were selected: Agomelatine in treatment-naïve patients as mono-therapy (A), in pretreated patients as add-on-therapy (B), and in pretreated patients switched to agomelatine (C). Effect on depressive symptoms was evaluated via svMADRS and CGI. Daytime functioning and sleep-wake rhythm were assessed by a patient-questionnaire. RESULTS The svMADRS decreased from values > 30 at baseline to 12.8 (total population), 10.3 (A), 15.1 (B), and 13.5 (C). 76.1%, 55.7%, and 62.5% of patients were responders in subgroups A, B, and C, respectively, 65.8% in the total population. Remission was achieved in 66.5% (A), 44.7% (B), and 50.9% (C) of patients. After 12 weeks, subjective sleep quality and daytime functioning improved in the majority of patients. Adverse drug reactions (ADR/serious ADR) were reported for 6.0%/0% (A), 11.0%/0.2% (B), and 12.6%/0.3% (C) of patients. Overall, 25.8% of patients discontinued treatment prematurely, 5.2% due to ADR. CONCLUSION Agomelatine improved depressive symptoms, daytime functioning, and sleep-wake rhythm, and demonstrated good tolerability also in pretreated patients and combination therapy under routine practice.
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Affiliation(s)
- Gerd Laux
- Kbo-Inn-Salzach-Klinikum, Hospital of Psychiatry, Psychotherapy, Psychosomatic Medicine and Neurology , Wasserburg am Inn , Germany
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Mechanism of action of agomelatine: a novel antidepressant exploiting synergy between monoaminergic and melatonergic properties. CNS Spectr 2014; 19:207-12. [PMID: 24901504 DOI: 10.1017/s1092852914000248] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A striking and unexpected pharmacologic synergy has been shown between antagonist actions at serotonergic 5HT2C receptors, and agonist actions at melatonergic receptors by agomelatine, a drug that has both of these properties.
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Taylor D, Sparshatt A, Varma S, Olofinjana O. Antidepressant efficacy of agomelatine: meta-analysis of published and unpublished studies. BMJ 2014; 348:g1888. [PMID: 24647162 PMCID: PMC3959623 DOI: 10.1136/bmj.g1888] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To systematically review published and unpublished efficacy studies of agomelatine in people with depression. DESIGN Systematic review and meta-analysis. DATA SOURCES Literature search (Pubmed, Embase, Medline), Cochrane Central Register of Controlled Trials, European Medicines Agency (EMA) regulatory file for agomelatine, manufacturers of agomelatine (Servier). ELIGIBILITY CRITERIA Double blind randomised placebo and comparator controlled trials of agomelatine in depression with standard depression rating scales. DATA SYNTHESIS Studies were pooled by using a random effects model with DerSimonian and Laird weights for comparisons with placebo and comparator antidepressant. The primary efficacy measure (change in rating scale score) was summarised with standardised mean difference (SMD; a measure of effect size) and secondary outcome measures with relative risks. All results were presented with 95% confidence intervals. Statistical heterogeneity was explored by visual inspection of funnel plots and by the I(2) statistic. Moderators of effect were explored by meta-regression. RESULTS We identified 20 trials with 7460 participants meeting inclusion criteria (11 in the published literature, four from the European Medicines Agency file, and five from the manufacturer). Almost all studies used the 17 item Hamilton depression rating scale (score 0-50). Agomelatine was significantly more effective than placebo with an effect size (SMD) of 0.24 (95% confidence interval 0.12 to 0.35) and relative risk of response 1.25 (1.11 to 1.4). Compared with other antidepressants, agomelatine showed equal efficacy (SMD 0.00, -0.09 to 0.10). Significant heterogeneity was uncovered in most analyses, though risk of bias was low. Published studies were more likely than unpublished studies to have results that suggested advantages for agomelatine. CONCLUSIONS Agomelatine is an effective antidepressant with similar efficacy to standard antidepressants. Published trials generally had more favourable results than unpublished studies.
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Affiliation(s)
- David Taylor
- King's College London, Institute of Pharmaceutical Science, London SE1 9NH, UK
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Hua P, Liu W, Chen D, Zhao Y, Chen L, Zhang N, Wang C, Guo S, Wang L, Xiao H, Kuo SH. Cry1 and Tef gene polymorphisms are associated with major depressive disorder in the Chinese population. J Affect Disord 2014; 157:100-3. [PMID: 24581835 PMCID: PMC4058073 DOI: 10.1016/j.jad.2013.11.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/22/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Accumulating evidences indicate that circadian abnormalities lead to sleep disorder, neurodegenerative diseases and depression. We have reported that the polymorphisms of a clock-related gene, Tef, contributed to the risk of sleep disturbances and depression in the Parkinson disease. The objective of the present study was to examine whether the three clock genes we previously studied are associated with major depressive disorder (MDD) in the Chinese population. METHODS 105 Subjects with MDD and 485 control subjects participated in this case-control study. Demographics, Mini-mental Status Examination (MMSE), and the Hamilton rating scale for depression (HAMD) were obtained in all subjects. Genotypes of single nucleotide polymorphisms (SNPs) of Cry1 rs2287161, Cry2 rs10838524 and Tef rs738499 were screened by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS MDD cases had a significantly higher frequency carrying the C allele and CC genotype in Cry1 rs2287161 and the T allele and TT genotype in Tef rs738499 than controls. LIMITATIONS The sample size of MDD group was relatively small. CONCLUSIONS The polymorphisms of Cry1 rs2287161 and Tef rs738499 are associated to MDD.
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Affiliation(s)
- Ping Hua
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Weiguo Liu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
| | - Donghui Chen
- Department of Neurology, University of Washington school of Medicine, Washington, 98195, United States
| | - Yanyan Zhao
- Department of Neurology, BenQ medical center Affiliated to Nanjing Medical University, Nanjing 210029, P.R. China
| | - Ling Chen
- Medical Psychology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Ning Zhang
- Medical Psychology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Chun Wang
- Medical Psychology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Suwan Guo
- Medical Psychology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Li Wang
- Clinical Laboratory, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Hong Xiao
- Institute of Scientific Research, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Sheng-Han Kuo
- Department of Neurology, The Neurological Institute of New York, Columbia University Medical Center, NY 10032, United States.
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Ettaoussi M, Pérès B, Jarry C, Nosjean O, Boutin JA, Gohier A, Mannoury la Cour C, Caignard DH, Delagrange P, Berthelot P, Yous S. Synthesis, chiral resolution, absolute configuration assignment and pharmacological evaluation of a series of melatoninergic ligands. MEDCHEMCOMM 2014. [DOI: 10.1039/c4md00149d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
(−)-R-Enantiomers of agomelatine analogues were more potent at serotonin 5-HT2C receptors than (+)-S-enantiomers, and showed antidepressant-like properties in a tail suspension test.
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Affiliation(s)
| | - Basile Pérès
- Univ Lille Nord de France
- , France
- UDSL
- EA GRIIOT
- UFR Pharmacie
| | | | - Olivier Nosjean
- Biotechnologies
- Pharmacologie Moléculaire et Cellulaire
- Institut de Recherches Servier
- , France
| | - Jean A. Boutin
- Biotechnologies
- Pharmacologie Moléculaire et Cellulaire
- Institut de Recherches Servier
- , France
| | - Arnaud Gohier
- Département des Sciences Expérimentales
- Institut de Recherches Servier
- , France
| | | | | | - Philippe Delagrange
- Département des Sciences Expérimentales
- Institut de Recherches Servier
- , France
| | | | - Saïd Yous
- Univ Lille Nord de France
- , France
- UDSL
- EA GRIIOT
- UFR Pharmacie
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Guaiana G, Gupta S, Chiodo D, Davies SJC, Haederle K, Koesters M. Agomelatine versus other antidepressive agents for major depression. Cochrane Database Syst Rev 2013; 2013:CD008851. [PMID: 24343836 PMCID: PMC11289707 DOI: 10.1002/14651858.cd008851.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Major depressive disorder (MDD), or depression, is a syndrome characterised by a number of behavioural, cognitive and emotional features. It is most commonly associated with a sad or depressed mood, a reduced capacity to feel pleasure, feelings of hopelessness, loss of energy, altered sleep patterns, weight fluctuations, difficulty in concentrating and suicidal ideation. There is a need for more effective and better tolerated antidepressants to combat this condition. Agomelatine was recently added to the list of available antidepressant drugs; it is a novel antidepressant that works on melatonergic (MT1 and MT2), 5-HT 2B and 5-HT2C receptors. Because the mechanism of action is claimed to be novel, it may provide a useful, alternative pharmacological strategy to existing antidepressant drugs. OBJECTIVES The objective of this review was 1) to determine the efficacy of agomelatine in alleviating acute symptoms of major depressive disorder in comparison with other antidepressants, 2) to review the acceptability of agomelatine in comparison with other antidepressant drugs, and, 3) to investigate the adverse effects of agomelatine, including the general prevalence of side effects in adults. SEARCH METHODS We searched the Cochrane Collaboration's Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to 31 July 2013. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 onwards), MEDLINE (1950 onwards) and PsycINFO (1967 onwards). We checked reference lists of relevant studies together with reviews and regulatory agency reports. No restrictions on date, language or publication status were applied to the search. Servier Laboratories (developers of agomelatine) and other experts in the field were contacted for supplemental data. SELECTION CRITERIA Randomised controlled trials allocating adult participants with major depression to agomelatine versus any other antidepressive agent. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and a double-entry procedure was employed. Information extracted included study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy, acceptability and tolerability. MAIN RESULTS A total of 13 studies (4495 participants) were included in this review. Agomelatine was compared to selective serotonin reuptake inhibitors (SSRIs), namely paroxetine, fluoxetine, sertraline, escitalopram, and to the serotonin-norepinephrine reuptake inhibitor (SNRI), venlafaxine. Participants were followed up for six to 12 weeks. Agomelatine did not show any advantage or disadvantage over the other antidepressants for our primary outcome, response to treatment (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.95 to 1.08, P value 0.75 compared to SSRIs, and RR 1.06; 95% CI 0.98 to 1.16, P value 0.16 compared to venlafaxine). Also, agomelatine showed no advantage or disadvantage over other antidepressants for remission (RR 0.83; 95% CI 0.68 to 1.01, P value 0.07 compared to SSRIs, and RR 1.08; 95% CI 0.94 to 1.24, P value 0.73 compared to venlafaxine). Overall, agomelatine appeared to be better tolerated than venlafaxine in terms of lower rates of drop outs (RR 0.40; 95% CI 0.24 to 0.67, P value 0.0005), and showed the same level of tolerability as SSRIs (RR 0.95; 95% CI 0.83 to 1.09, P value 0.44). Agomelatine induced a lower rate of dizziness than venlafaxine (RR 0.19, 95% CI 0.06 to 0.64, P value 0.007).With regard to the quality of the body of evidence, there was a moderate risk of bias for all outcomes, due to the number of included unpublished studies. There was some heterogeneity, particularly between published and unpublished studies. The included studies were conducted in inpatient and outpatient settings, thus limiting the generalisability of the results to primary care settings. With regard to precision, the efficacy outcomes were precise, but the tolerability outcomes were mostly imprecise. Publication bias was variable and depended on the outcome of the trial. Our review included unpublished studies, and we think that this reduced the impact of publication bias. The overall methodological quality of the studies was not very good. Almost all of the studies were sponsored by the pharmaceutical company that manufactures agomelatine (Servier), and some of these were unpublished. Attempts to contact the pharmaceutical company Servier for additional information on all unpublished studies were unsuccessful. AUTHORS' CONCLUSIONS Agomelatine did not seem to provide a significant advantage in efficacy over other antidepressive agents for the acute-phase treatment of major depression. Agomelatine was better tolerated than paroxetine and venlafaxine in terms of overall side effects, and fewer participants treated with agomelatine dropped out of the trials due to side effects compared to sertraline and venlafaxine, but data were limited because the number of included studies was small. We found evidence that compared agomelatine with only a small number of other active antidepressive agents, and there were only a few trials for each comparison, which limits the generalisability of the results. Moreover, the overall methodological quality of the studies was low, and, therefore, no firm conclusions can be drawn concerning the efficacy and tolerability of agomelatine.
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Affiliation(s)
- Giuseppe Guaiana
- Western UniversityDepartment of PsychiatrySaint Thomas Elgin General Hospital189 Elm StreetSt ThomasOntarioCanadaN5R 5C4
| | - Sumeet Gupta
- Tees, Esk & Wear Valleys NHS Foundation TrustGeneral Adult PsychiatryHundens Lane Resource CentreDarlingtonDurhamUKDL1 1DT
| | - Debbie Chiodo
- Centre for Addiction and Mental HealthSocial and Epidemiological Research Department100 Collip Circle Suite 100LondonOntarioCanadaN6G 4X8
| | - Simon JC Davies
- University of BristolSchool of Social and Community MedicineCotham HouseCotham HillBristolUKBS6 6JL
| | - Katja Haederle
- Ulm UniversityDepartment of Psychiatry IILudwig‐Heilmeyer‐Str. 2GuenzburgGermanyD‐89312
| | - Markus Koesters
- Ulm UniversityDepartment of Psychiatry IILudwig‐Heilmeyer‐Str. 2GuenzburgGermanyD‐89312
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MacIsaac SE, Carvalho AF, Cha DS, Mansur RB, McIntyre RS. The mechanism, efficacy, and tolerability profile of agomelatine. Expert Opin Pharmacother 2013; 15:259-74. [DOI: 10.1517/14656566.2014.862233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
BACKGROUND Migraine is a primary headache disorder characterized by recurrent episodes of headache associated with gastrointestinal, neurologic, and autonomic symptoms. Some evidence in literature suggests that the melatonergic system possibly plays an important role in the pathogenesis of migraine. Few studies have been performed on the use of melatonin as an antimigraine agent. Other than amitriptyline, few antidepressants have been found to be efficacious for migraine prophylaxis. Among antidepressants, agomelatine has a novel neurochemical mechanism. It is an melatonin receptor 1 and melatonin receptor 2 melatonergic receptor agonist and a selective antagonist of the 5-hydroxytryptamine (serotonin) receptor 2C receptors. CASES We report two cases of patients with migraine successfully treated with agomelatine; one patient presented with comorbid depression, whereas the other had no comorbidities. DISCUSSION Given its specific mechanism of action and similarity with melatonin, agomelatine may be a promising new treatment option for migraine prophylaxis. The potential therapeutic action of agomelatine could be due to its synergistic action on both melatonergic and 5-HT2C receptors.
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Agomelatine: an agent against anhedonia and abulia? J Neural Transm (Vienna) 2013; 122 Suppl 1:S3-7. [DOI: 10.1007/s00702-013-1126-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/19/2013] [Indexed: 01/13/2023]
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Adler UC, Krüger S, Teut M, Lüdtke R, Schützler L, Martins F, Willich SN, Linde K, Witt CM. Homeopathy for depression: a randomized, partially double-blind, placebo-controlled, four-armed study (DEP-HOM). PLoS One 2013; 8:e74537. [PMID: 24086352 PMCID: PMC3781106 DOI: 10.1371/journal.pone.0074537] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 07/24/2013] [Indexed: 11/18/2022] Open
Abstract
Background The specific clinical benefit of the homeopathic consultation and of homeopathic remedies in patients with depression has not yet been investigated. Aims To investigate the 1) specific effect of individualized homeopathic Q-potencies compared to placebo and 2) the effect of an extensive homeopathic case taking (case history I) compared to a shorter, rather conventional one (case history II) in the treatment of acute major depression (moderate episode) after six weeks. Methods A randomized, partially double-blind, placebo-controlled, four-armed trial using a 2×2 factorial design with a six-week study duration per patient was performed. Results A total of 44 from 228 planned patients were randomized (2∶1∶2∶1 randomization: 16 homeopathic Q-potencies/case history I, 7 placebo/case history I, 14 homeopathic Q-potencies/case history II, 7 placebo/case history II). Because of recruitment problems, the study was terminated prior to full recruitment, and was underpowered for the preplanned confirmatory hypothesis testing. Exploratory data analyses showed heterogeneous and inconclusive results with large variance in the sample. The mean difference for the Hamilton-D after 6 weeks was 2.0 (95%CI −1.2;5.2) for Q-potencies vs. placebo and −3.1 (−5.9;−0.2) for case history I vs. case history II. Overall, no consistent or clinically relevant results across all outcomes between homeopathic Q-potencies versus placebo and homeopathic versus conventional case taking were observed. The frequency of adverse events was comparable for all groups. Conclusions Although our results are inconclusive, given that recruitment into this trial was very difficult and we had to terminate early, we cannot recommend undertaking a further trial addressing this question in a similar setting. Prof. Dr. Claudia Witt had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Trial registration clinicaltrials.gov identifier NCT01178255. Protocol publication:http://www.trialsjournal.com/content/12/1/43
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Affiliation(s)
- Ubiratan C. Adler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Krüger
- Teaching Hospital of the Charite – Universitätsmedizin Berlin, Head Center for Women’s Mental Health, Vivantes Humboldt Klinik, Berlin, Germany
| | - Michael Teut
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Rainer Lüdtke
- Karl and Veronica Carstens Foundation, Essen, Germany
| | - Lena Schützler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Martins
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan N. Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus Linde
- Institute of General Practice, Technische Universität München, Munich, Germany
| | - Claudia M. Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
- University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Ettaoussi M, Sabaouni A, Pérès B, Landagaray E, Nosjean O, Boutin JA, Caignard DH, Delagrange P, Berthelot P, Yous S. Synthesis and Pharmacological Evaluation of a series of the Agomelatine Analogues as Melatonin MT1/MT2Agonist and 5-HT2CAntagonist. ChemMedChem 2013; 8:1830-45. [DOI: 10.1002/cmdc.201300294] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Indexed: 01/08/2023]
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Koesters M, Guaiana G, Cipriani A, Becker T, Barbui C. Agomelatine efficacy and acceptability revisited: systematic review and meta-analysis of published and unpublished randomised trials. Br J Psychiatry 2013; 203:179-87. [PMID: 23999482 DOI: 10.1192/bjp.bp.112.120196] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Agomelatine is a novel antidepressant drug with narrative, non-systematic reviews making claims of efficacy. AIMS The present study systematically reviewed published and unpublished evidence of the acute and long-term efficacy and acceptability of agomelatine compared with placebo in the treatment of major depression. METHOD Randomised controlled trials comparing agomelatine with placebo in the treatment of unipolar major depression were systematically reviewed. Primary outcomes were (a) Hamilton Rating Scale for Depression (HRSD) score at the end of treatment (short-term studies) and (b) number of relapses (long-term studies). RESULTS Meta-analyses included 10 acute-phase and 3 relapse prevention studies. Seven of the included studies were unpublished. Acute treatment with agomelatine was associated with a statistically significant superiority over placebo of -1.51 HRSD points (99% CI -2.29 to -0.73, nine studies). Data extracted from three relapse prevention studies failed to show significant effects of agomelatine over placebo (relative risk 0.78, 99% CI 0.41-1.48). Secondary efficacy analyses showed a significant advantage of agomelatine over placebo in terms of response (with no effect for remission). None of the negative trials were published and conflicting results between published and unpublished studies were observed. CONCLUSIONS We found evidence suggesting that a clinically important difference between agomelatine and placebo in patients with unipolar major depression is unlikely. There was evidence of substantial publication bias.
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Pompili M, Serafini G, Innamorati M, Venturini P, Fusar-Poli P, Sher L, Amore M, Girardi P. Agomelatine, a novel intriguing antidepressant option enhancing neuroplasticity: a critical review. World J Biol Psychiatry 2013; 14:412-31. [PMID: 23530731 DOI: 10.3109/15622975.2013.765593] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The treatment of major affective disorders, commonly associated with high disability and elevated social costs may be still considered unsatisfactory. Among all antidepressant drugs, predominantly acting through monoaminergic mechanisms, agomelatine is of particular interest due to another alternative mechanism of action. Targeting melatonergic receptors, agomelatine play a crucial role in synchronizing circadian rhythms, known to be altered in depressed subjects. METHODS A critical review of the literature focusing on efficacy, safety and tolerability of agomelatine in major affective disorders was performed. Additionally, we focused on the potential of agomelatine in enhancing neuroplasticity mechanisms and promote neurogenesis. A total of 136 articles from peer-reviewed journals were identified, of which 50 were assessed for eligibility and 21 were included. RESULTS Agomelatine, a melatonergic analogue drug acting as MT1/MT2 agonist and 5-HT2C antagonist, has been reported to be effective as antidepressant drug. Studies confirmed not only clinical efficacy but also safety and tolerability of agomelatine. Also, it enhances neuroplasticity mechanisms and adult neurogenesis in brain areas such as hippocampus and prefrontal cortex. CONCLUSIONS Agomelatine actually represents an intriguing option in the treatment of affective disorders.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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De Berardis D, Marini S, Fornaro M, Srinivasan V, Iasevoli F, Tomasetti C, Valchera A, Perna G, Quera-Salva MA, Martinotti G, di Giannantonio M. The melatonergic system in mood and anxiety disorders and the role of agomelatine: implications for clinical practice. Int J Mol Sci 2013; 14:12458-83. [PMID: 23765220 PMCID: PMC3709794 DOI: 10.3390/ijms140612458] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 05/22/2013] [Accepted: 05/22/2013] [Indexed: 02/07/2023] Open
Abstract
Melatonin exerts its actions through membrane MT1/MT2 melatonin receptors, which belong to the super family of G-protein-coupled receptors consisting of the typical seven transmembrane domains. MT1 and MT2 receptors are expressed in various tissues of the body either as single ones or together. A growing literature suggests that the melatonergic system may be involved in the pathophysiology of mood and anxiety disorders. In fact, some core symptoms of depression show disturbance of the circadian rhythm in their clinical expression, such as diurnal mood and other symptomatic variation, or are closely linked to circadian system functioning, such as sleep-wake cycle alterations. In addition, alterations have been described in the circadian rhythms of several biological markers in depressed patients. Therefore, there is interest in developing antidepressants that have a chronobiotic effect (i.e., treatment of circadian rhythm disorders). As melatonin produces chronobiotic effects, efforts have been aimed at developing agomelatine, an antidepressant with melatonin agonist activity. The present paper reviews the role of the melatonergic system in the pathophysiology of mood and anxiety disorders and the clinical characteristics of agomelatine. Implications of agomelatine in "real world" clinical practice will be also discussed.
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Affiliation(s)
- Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy; E-Mail:
- Department of Neuroscience and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti 66013, Italy; E-Mails: (G.M.); (M. G.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-0861429708; Fax: +39-0861429706
| | - Stefano Marini
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy; E-Mail:
- Department of Neuroscience and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti 66013, Italy; E-Mails: (G.M.); (M. G.)
| | - Michele Fornaro
- Department of “Scienze della Formazione”, University of Catania, Catania 95121, Italy; E-Mail:
| | - Venkataramanujam Srinivasan
- Sri Sathya Sai Medical Educational and Research Foundation, Medical Sciences Research Study Center, Prasanthi Nilayam, 40-Kovai Thirunagar Coimbatore, Tamilnadu 641014, India; E-Mail:
| | - Felice Iasevoli
- Laboratory of Molecular Psychiatry and Psychopharmacotherapeutics, Section of Psychiatry, Department of Neuroscience, University School of Medicine “Federico II”, Naples 80131, Italy; E-Mails: (F.I.); (C.T.)
| | - Carmine Tomasetti
- Laboratory of Molecular Psychiatry and Psychopharmacotherapeutics, Section of Psychiatry, Department of Neuroscience, University School of Medicine “Federico II”, Naples 80131, Italy; E-Mails: (F.I.); (C.T.)
| | - Alessandro Valchera
- Hermanas Hospitalarias, FoRiPsi, Villa S. Giuseppe Hospital, Ascoli Piceno 63100, Italy; E-Mail:
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Albese con Cassano, Como 22032, Italy; E-Mail:
- Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, 33124 Miami, USA
- Department of Psychiatry and Neuropsychology, University of Maastricht, 6200 MD Maastricht, The Netherlands
| | - Maria-Antonia Quera-Salva
- AP-HP Sleep Unit, Department of Physiology, Raymond Poincaré Hospital, Garches 92380, France; E-Mail:
| | - Giovanni Martinotti
- Department of Neuroscience and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti 66013, Italy; E-Mails: (G.M.); (M. G.)
| | - Massimo di Giannantonio
- Department of Neuroscience and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti 66013, Italy; E-Mails: (G.M.); (M. G.)
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Agomelatine-induced hepatotoxicity. Wien Klin Wochenschr 2013; 125:225-6. [PMID: 23519541 DOI: 10.1007/s00508-013-0344-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/25/2013] [Indexed: 01/13/2023]
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