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New antidepressant superior to fluoxetine, trial finds

By Lilian Anekwe

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.

Agomelatine was found to be significantly superior to fluoxetine at treating depression Agomelatine was found to be significantly superior to fluoxetine at treating depression

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