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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Netch on September 25, 2009, at 3:32:47
"New antidepressant superior to fluoxetine, trial finds
The first in a new generation of antidepressants - the first to be launched in more than 10 years - has been shown to be more effective than fluoxetine for severe depression, an international study has found.
Previous data on agomelatine - the first melatonin receptor agonist suggested it performed better than both venlafaxine and sertraline in two randomised trials of 332 patients.
In the new study 515 adults with major depressive disorder in 41 centres worldwide including 11 UK centres were randomised for eight weeks to either fluoxetine 20 or 40mg daily, or a 25 or 50mg daily dose of agomelatine.
Agomelatine was significantly superior to fluoxetine, with a 1.5-point improvement in the Hamilton depression score seen in patients treated with agomelatine.
The new drug does not increase blood levels of serotonin which has led to suggestions that it might not cause adverse events associated with SSRIs. But in this new trial there were no relevant differences between the two drugs in terms of new adverse events.
Agomelatine was launched in the UK by manufacturer Servier in June at a pack price of £38.53 for a packet of 28 25mg tablets compared to the £1.02 net cost of a 30-cap pack of 20mg fluoxetine.
Professor Tony Hale, head of psychiatry at the University of Kent and leader of the UK arm of the study said the results showed GPs should consider agomelatine as a new and important alternative for the treatment of depression.
Dr Mark Ashworth, a GP in Kennington, south London with an interest in mental health, said he would be keen to see a primary care trial before considering prescribing agomelatine, as it's only a primary care trial that's likely to influence prescribing.
The results were presented at the European Congress of Neuropsychopharmacology in Istanbul earlier this month. "
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4123700&c=2
Posted by manic666 on September 25, 2009, at 12:27:07
In reply to Agomelatine superior to Fluoxetine, posted by Netch on September 25, 2009, at 3:32:47
we no ago sounds good , but p docs in england are not ready to offer it yet. they are nhs run an if the price is high you wont get it on the nhs. only the cheap genitic,s for us .
Posted by willyeee on September 25, 2009, at 13:25:48
In reply to Agomelatine superior to Fluoxetine, posted by Netch on September 25, 2009, at 3:32:47
i HAVE SOME COMMING SO EXCITIED!
Posted by sowhysosad on September 25, 2009, at 14:48:52
In reply to Re: Agomelatine superior to Fluoxetine, posted by manic666 on September 25, 2009, at 12:27:07
> we no ago sounds good , but p docs in england are not ready to offer it yet. they are nhs run an if the price is high you wont get it on the nhs. only the cheap genitic,s for us .
I dunno - another thread here on Babble suggests the NHS are looking into it.
I can see some more progressive GP's with specialities in mental health using it, much like they have with other expensive on-patent drugs like Efexor and Cipralex (Lexapro to our friends in the US of States).
Just because a drug isn't recommended by NICE, it doesn't mean to say some docs won't use it.
Posted by SLS on September 25, 2009, at 15:37:07
In reply to Re: Agomelatine superior to Fluoxetine, posted by willyeee on September 25, 2009, at 13:25:48
> i HAVE SOME COMMING SO EXCITIED!
Will you be combining agomelatine with Parnate?
- Scott
Posted by willyeee on September 25, 2009, at 15:48:41
In reply to Re: Agomelatine superior to Fluoxetine » willyeee, posted by SLS on September 25, 2009, at 15:37:07
aT FIRST YESS,BUT OUR GOAL WERE WORKING ON IS TO REPLACE PARNATE,ITS TIME TO HANG IT UP FOR ME.
Posted by SLS on September 25, 2009, at 18:34:12
In reply to Re: Agomelatine superior to Fluoxetine, posted by willyeee on September 25, 2009, at 15:48:41
> aT FIRST YESS,BUT OUR GOAL WERE WORKING ON IS TO REPLACE PARNATE,ITS TIME TO HANG IT UP FOR ME.
I wish you luck. I hope your discontinuation of Parnate is uneventful.
- Scott
Posted by bleauberry on September 26, 2009, at 18:02:03
In reply to Agomelatine superior to Fluoxetine, posted by Netch on September 25, 2009, at 3:32:47
Due to clinical study flaws, biases, politics, financial backers, and tricks of statisticians, I don't hold a lot of integrity in studies. They are a decent overall general view however. While a 1.5 point difference is significant as determined the statisticians in one study, it does not reach significance in antoher. Either way, I do not believe a 1.5 point difference is something any of us are likely to feel as a significant difference in our daily lives. It could easily be from the sleep question of the survey where sleep quality was improved enough to make a 1.5 point difference in the total score, but no effect otherwise in pleasure, hobbies, motivation, energy, pain, appetite, etc. Just a hypothetical example to show how easily a 1.5 point difference can actually not mean much.
All that said, I do like Agomelatine for several reasons. One, it is a new approach, a new mechanism, not a me-too copycat. Two, it does not artificially increase serotonin by way of reuptake inhibition. Three, many chronic diseases are showing hints of having some kind of melatonin connection. But still, to see the pharm giants at least put some emphasis somewhere else besides SSRI/SNRI is refreshing.
Years later we will discover what the true strengths, the true weaknesses, and the true side effects of this new drug are. For now, on paper, it looks to me like a refreshing new approach to psychiatry. I hope it pans out better than the 1.5 point difference.
Posted by linkadge on September 27, 2009, at 16:05:57
In reply to Re: Agomelatine superior to Fluoxetine, posted by bleauberry on September 26, 2009, at 18:02:03
I don't know how well it will work in those who have been previosly exposed to reuptake inhibitors.
I personally think reuptake inhibitors induce adaptive responses that can last much longer than the period of drug administration. So, if you come off something like parante and go onto something with a seemingly much gentler clinical action, it may take a while to respond.
I think agomelatine is probably going to be more effective in AD naive patients. But I do think, if it is effective, that it could produce a higher rate of remission, in the sense that there will likely be a relative absense of side effects.
Linkadge
Posted by West on October 1, 2009, at 15:42:41
In reply to Re: Agomelatine superior to Fluoxetine » willyeee, posted by SLS on September 25, 2009, at 15:37:07
I dunno
Jan Wise who my brother sees has done a lot of research on it and seems unconvinced.
This is the end of the thread.
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