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The many symptoms of depression …
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The many symptoms of depression …
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The many symptoms of depression …
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Expectations of our depressed patients
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Snaith-Hamilton Pleasure Scale (SHAPS)
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Which antidepressant ? Sertraline ? Bupropion ?
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The efficacy of antidepressants on anhedonia
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Effects on CHEER Index (primary outcome)
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Effects on depression severity (secondary outcomes)
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Effects on anxiety severity (secondary outcomes)
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Group comparisons on CHEER index scores (primary outcome)
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Group comparisons on depression severity (secondary outcomes)
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Group comparisons on anxiety severity (secondary outcomes)
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First study (secondary outcome)
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Valdoxan: SmPC recomandations
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1st reason why agomelatine improves anhedonia so fast.
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Valdoxan: A New Antidepressant With Novel Pharmacology
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2nd reason why agomelatine improves anhedonia so fast.
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Serotonin (5-HT) Inhibits Dopamine (DA) and Norepinephrine (NE) Release via 5-HT2C Receptors
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Ago ↓ Stress-induced glutamate release
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Agomelatine: potential impacts on glutamatergic neurotransmission
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1. Delayed onset of action of monoaminergic antidepressant.2. Star*D SSRI treatment for 14 weeks, remission rate around 30% (1st treatment level)
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3rd reason why agomelatine improves anhedonia so fast.
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4th reason why agomelatine improves anhedonia so fast.
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A further possible reason : it is about anxiety
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Anxious Distress: A New Specifier for MDD
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MDD with anxiety symptoms were associated with early onset, poor course and functioning
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Remission Rates With Antidepressant Treatment in Anxious vs Nonanxious Depression
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Anxiety depression is the hurdle for MDD remission. Sensitive to drugs’ side effects
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Agomelatine versus SSRI/SNRI
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Anxiety depression is the hurdle for MDD remission. Sensitive to drugs’ side effects
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Remission Rates With Antidepressant Treatment in Anxious vs Nonanxious Depression
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Anxiety depression is the hurdle for MDD remission. Sensitive to drugs’ side effects
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Agomelatine versus SSRI/SNRI
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Anxiety enhances- acute exposure of SSRI
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The underlying mechanism
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Extended amygdala
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Anxiety and fear-promoting circuit in the extended amygdala
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Anxiety and fear-promoting circuit in the extended amygdala
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Anxiety and fear-promoting circuit in the extended amygdala
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Anxiety and fear-promoting circuit in the extended amygdala
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2016 CANMAT GuidelinesAgomelatine recommended as a first line antidepressant
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Valdoxan provides combinedgood efficacy with the best acceptability
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Case sharing
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Thanks for your attention
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