Agomelatine: a new option for treatment of depression?

A number of diverse antidepressants with different mechanisms of action are available today. However, the mechanisms of action of US FDA-approved antidepressants still mainly rely on targeting monoamine neurotransmitters. The inadequate remission and response rates achieved by antidepressant treatment for depression have been well known through a number of manufacturer-sponsored randomized, placebo-controlled, clinical trials (RCTs), independent RCTs, some large practical clinical trials and many meta-analyses. In the light of the limited efficacy of currently available antidepressants and the need for an antidepressant with a novel mechanism of action, the availability of agomelatine is prudent and timely for clinical practice. Although agomelatine has been approved for the treatment of depression in Europe and some other countries, its clear efficacy has been questionable based on results from individual RCTs and meta-analyses. However, agomelatine may be more beneficial in specific populations such as those who suffer from unwanted adverse events (AEs) (i.e., sexual dysfunction) by current antidepressants or elderly populations who are vulnerable to AEs. Based on currently available findings, agomelatine may not be recommendable as the first-line antidepressant for treating depression; especially, its putative benefits compared with other antidepressants must be thoroughly studied in adequately powered and well-designed future clinical trials.