Dear Editor,
As a proponent of guidelines for the treatment of Major Depressive Disorder (MDD), I read with interest the “Guía de atención Integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos”, published in the December issue of Revista Colombiana de Psiquiatría,1 and I congratulate the authors on this contribution to improving the lives of people with MDD.
However, I must take exception to the comments regarding agomelatine that “the use of agomelatine is not recommended because there is not enough evidence at this time to support its efficacy”.
I am the author of an extensive review published in 2010 on the clinical evidence from published and unpublished trials up to 2010 involving placebo controlled trials and direct head to head comparisons with a broad range of currently prescribed antidepressants2. The evidence to support clinical efficacy and excellent tolerability is robust. Since then, new clinical trials have been published and have been the subject of two additional reviews. In the first one, Kasper et al3 reported the results of a meta-analysis of individual patient data from the direct head-to-head double-blind randomized studies, from 6 to 12 weeks of duration, comparing agomelatine with other antidepressants where the HAM-D17 was the primary outcome measure. These authors reported a greater reduction of the HAM-D17 with agomelatine than with SSRI/SNRI (0.86±0.35, 95% confidence interval, 0.18–1.53; P=.013).
The second publication4, meta-analysis evaluated the efficacy of agomelatine at 24 weeks, compared with selective serotonin reuptake inhibitors (SSRIs), based on the results of four randomized clinical trials4. At the last post-baseline assessment of the 24-week treatment period, there was a significant difference on HAM-D17 final scores in patients treated with agomelatine compared to those treated with SSRIs (P=.014). Quite appropriately, the Columbian guide places strong emphasis on HAM-D remission rates. Remission rates for agomelatine were numerically but not significantly higher in patients treated with SSRIs at 24 weeks. In this report, Demyttenaere et al4 concluded that “from a clinical point of view, agomelatine is at least as efficacious as the investigated SSRIs”.
Given the overall disappointing rates of response and remission reported in STAR*D5, physicians should be made aware of all options to treat their depressed patients. Agomelatine, with a unique mode of action and a strong evidence base for efficacy and effectiveness, should certainly be included as a treatment option. I consider that there is adequate evidence to support the use of agomelatine as a first line treatment for major depressive episodes.
