Content area
Full Text
Neuroscience and Behavioral Physiology, Vol. 43, No. 7, September, 2013
Use of Valdoxan (Agomelatin) in the Combined Treatment of Moderate and Severe Nonpsychotic Depression
V. E. Medvedev
Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 112, No. 5, pp. 3740, Iss. I, May, 2012.
Analysis of data obtained during the VREMYA trial showed that combined use of the melatoninergic antidepressant Valdoxan with antidepressants of other groups is highly effective in treating moderate and severe forms of nonpsychotic depression without producing serious adverse events. The author believes that this provides grounds for proposing that this combination of agents be used in the treatment of refractory affective disorders.
Keywords: neuropsychotic depression, treatment, Valdoxan.
Assessment of the efficacy of antidepressant treatment is based on the following criteria: decreases in the severity of depressive symptomatology on the Montgomery scale (or the Hamilton scale) by 50% correspond to good effects, decreases by 2140% correspond to moderate effects, and decreases by less than 21% correspond to minor effects [19, 28]. The appropriate antidepressant dose is taken as the dose equivalent to 200 mg of imipramine or 200300 mg of amitriptyline [14, 26].
According to current concepts, depression is regarded as refractory when two sequential courses (each of 34 weeks) of appropriate monotherapy with pharmacologically different agents produce no or minor clinical effects [2, 8, 11, 16].
Various authors believe [2, 13, 18] that about 2030% of patients with depression do not respond to treatment with single antidepressants and only 4050% receiving thymoleptics remain on this treatment and are sensitive to it after 46 weeks of treatment [4, 30]. In addition, some studies [22, 31] have presented data showing that up to 60% of patients do not achieve complete remission of hypothymic symptomatology on the background of courses of treatment(i.e., they are refractory to thymoanaleptic agents), and 20%
of patients have depressive symptoms persisting for more than two years on the background of treatment. Approaches to treatment of therapeutically refractory depression vary, because of the clinical and biochemical heterogeneity of depression. Thus, about half of patients can mount favorable therapeutic responses on substitution of one antidepressant by another [4, 30].
At the present stage of development of the psychopharmacological treatment of depression, first-line agents are selective antidepressants of the...