Editorial GM Goodwin
University Department of Psychiatry, Warneford Hospital, Headington, Oxford, UK.
Major depression is sometimes described as the common cold of psychiatry. Although this analogy fairly captures the frequency with which major depression arises, it risks diminishing its importance as a source of misery and disability. Moreover, the very word depression has become devalued by everyday use. As the novelist William Styron put it so graphically in his account of being depressed, Darkness Visible: A Memoir of Madness: ‘Depression is a wimp of a word… the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control’. Depression may be either recurrent or chronic, and in either manifestation, it is a seriously impairing disease. The subjective symptoms of depression are perhaps obvious, the effects on memory and executive function perhaps less so. The treatment of depression, especially its severe forms in which melancholic symptoms predominate, is usually with one of the large number of medicines developed in the last 20 years. Although the selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) represented an advance on the tricyclic drugs, certainly in the burden of side effects, there remains significant unmet need because existing treatments are neither as effective nor as free of adverse effects as we would hope and, perhaps, believe (Trivedi, et al., 2006).
Corresponding author: Guy M Goodwin. Email: [email protected]
Journal of Psychopharmacology 22(7) Supplement (2008) 3 © 2008 British Association for Psychopharmacology ISSN 0269-8811 SAGE Publications Ltd, Los Angeles, London, New Delhi and Singapore 10.1177/0269881108094716
Agomelatine is a new antidepressant with a novel profile of pharmacological action. In this supplement, we have attempted to summarise its pharmacology (Philip Gorwood), its efficacy as reported in controlled trials (Guy Goodwin), its effects on circadian biology (Raymond Lam) and its tolerability and potential clinical utility (Sidney Kennedy). The challenge for any new medication is to show therapeutic advance. It is not enough, of course, simply to replicate the properties of an earlier generation of effective medicines. In this respect, agomelatine has two major advantages. First, its mechanism of action is unique and its selective interaction with the melatonergic and 5-HT2C receptor systems offers the potential for a regulation of circadian function in depressed patients that has not been possible with previous medications. Second, its freedom from adverse, gastrointestinal and sexual effects is remarkable, in comparison with other antidepressants. This will mean a greater acceptability to patients and the potential to realise the efficacy in recurrent major depression that has been reported in long-term relapse prevention studies.
Reference Trivedi, MH, Rush, AJ, Wisniewski, SR, Nierenberg, AA, Warden, D, Ritz, L, et al. (2006) Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. Am J Psychiatry 163: 28–40.