Efficacy of agomelatine and escitalopram on depression, subjective sleep and emotional experiences in patients with major depressive disorder: a 24-wk randomized, controlled, double-blind trial

Jul 5, 2013The international journal of neuropsychopharmacology

Effects of agomelatine and escitalopram on depression, sleep quality, and emotions in people with major depression over 24 weeks

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Abstract

Agomelatine resulted in a lower incidence of treatment discontinuation due to adverse events compared to escitalopram (5.5% vs. 10.6%).

Both agomelatine and escitalopram similarly improved depressive symptoms, with notable remission rates at 12 weeks (60.9% for agomelatine, 54.4% for escitalopram) and at 24 weeks (69.6% for agomelatine, 63.1% for escitalopram).
Satisfaction with sleep improved in both treatment groups, with no significant difference in overall sleep quality between agomelatine and escitalopram.
Patients taking agomelatine reported a greater improvement in the feeling of wellness upon waking compared to those on escitalopram (p = 0.02).
In patients with pronounced sleep complaints, agomelatine led to significantly greater improvements in both sleep quality and feeling on waking compared to escitalopram (p = 0.016 and p = 0.009, respectively).
Emotional blunting was reported less frequently with agomelatine, with 28% of patients experiencing it compared to 60% with escitalopram (p = 0.024).

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In the present randomized, controlled, double-blind trial (12 wk treatment plus double-blind extension for 12 wk), 25-50 mg/d agomelatine (n = 164) and 10-20 mg/d escitalopram (n = 160) were compared for short- and long-term efficacy, subjective sleep and tolerability. The effects of these drugs on emotional experiences were also compared in patients having completed the Oxford Questionnaire on the Emotional Side-Effects of Antidepressants (agomelatine: n = 25; escitalopram: n = 20). Agomelatine and escitalopram similarly improved depressive symptoms, with clinically relevant score changes over 12 and 24 wk and notable percentage of remitters (week 12: 60.9 and 54.4%; week 24: 69.6 and 63.1% respectively). Over the 12 and 24-wk treatment periods, the 'global satisfaction on sleep' scores increased in both treatment groups and did not differ between groups. Satisfaction with sleep-wake quality was high in both groups; the 'wellness feeling on waking' was more improved with agomelatine than with escitalopram (p = 0.02). In patients with pronounced sleep complaints, quality of sleep and feeling on waking were significantly more improved with agomelatine than with escitalopram (p = 0.016 and p = 0.009, respectively). Emotional blunting was less frequent on agomelatine than on escitalopram. Indeed, 28% of patients on agomelatine vs. 60% on escitalopram felt that their emotions lacked intensity and 16% of patients on agomelatine vs. 53% on escitalopram felt that things that they cared about before illness did not seem important any more (p = 0.024). The tolerability profile of agomelatine was found to be superior to that of escitalopram and the incidence of patients with at least one emergent adverse event leading to treatment discontinuation was lower in the agomelatine group than in the escitalopram group (5.5 vs. 10.6%). The findings suggest that agomelatine displays additional long-term clinical benefits on sleep-wake quality and emotional experiences over escitalopram in the management of depression.

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Efficacy of agomelatine and escitalopram on depression, subjective sleep and emotional experiences in patients with major depressive disorder: a 24-wk randomized, controlled, double-blind trial

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