Agomelatine, a novel antidepressant, demonstrates comparable efficacy to venlafaxine in treating major depressive disorder (MDD) but offers A Major Improvement Compared To venlafaxine in subjective sleep quality. This article explores a double-blind, randomized study comparing the effects of agomelatine and venlafaxine on sleep in MDD patients.
Agomelatine vs. Venlafaxine: Study Design and Methodology
The study involved 332 patients diagnosed with MDD according to DSM-IV criteria. Participants were randomly assigned to receive either agomelatine (25-50 mg/day) or venlafaxine (75-150 mg/day) for six weeks, with potential dose adjustments after two weeks. The Leeds Sleep Evaluation Questionnaire (LSEQ) measured subjective sleep quality, focusing on the “getting to sleep” score as the primary efficacy criterion. Antidepressant efficacy was evaluated using the 17-item Hamilton Rating Scale for Depression (HAM-D) and the Clinical Global Impressions (CGI) scale.
Superior Sleep Improvement with Agomelatine
After six weeks, both agomelatine and venlafaxine demonstrated similar antidepressant efficacy. However, agomelatine showcased a major improvement compared to venlafaxine in the LSEQ “getting to sleep” score (70.5 +/- 16.8 mm for agomelatine vs. 64.1 +/- 18.2 mm for venlafaxine, p = .001). This significant difference was observed as early as week one.
Furthermore, agomelatine exhibited statistically significant improvements in secondary sleep parameters, including LSEQ quality of sleep (p = .021), sleep awakenings (p = .040), and integrity of behavior (p = .024). Agomelatine also showed a major improvement compared to venlafaxine in the HAM-D insomnia score (sum of items 4, 5, and 6, p = .044) and the CGI global improvement score (p = .016).
Tolerability and Adverse Events
The incidence of adverse events was comparable between the two groups (52.1% for agomelatine and 57.1% for venlafaxine). However, withdrawals due to adverse events were significantly less frequent with agomelatine (4.2%) than with venlafaxine (13.2%). This suggests that agomelatine may offer a more tolerable treatment option.
Conclusion: Agomelatine Offers Significant Advantages in Sleep Quality
This study indicates that while agomelatine and venlafaxine offer similar antidepressant effects, agomelatine provides a major improvement compared to venlafaxine in subjective sleep quality for individuals with MDD. This improvement is evident early in treatment and extends across various sleep parameters. The favorable tolerability profile of agomelatine further strengthens its position as a valuable treatment option for MDD patients experiencing sleep disturbances.
