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In the recent years the aim of drug therapy in depression was redefined and specified. According to this, the main goal of antidepressant treatment goes beyond achieving some degree of response, or full response in the sense of 50% reduction of a depression score, but to remission in the global sense as well as on a more differentiated level, which means almost complete relief of depressive symptoms or at least almost complete relief of the core or most relevant symptoms of depression. This redefinition of the major therapeutic goal of antidepressive treatment was necessary, because several long-term studies demonstrated, that only remission and in this context the relief of the core or most relevant symptoms of depression can guarantee with a reasonably high probability a positive outcome under long-term aspects. The presentation will focus especially on the issue of relief of the core or the most relevant symptoms of depression and the respective efficacy of drug treatment with the recently licensed antidepressant agomelatine. Traditionally, especially depressed mood and lack of interest were seen as the core symptoms of depression. This is also mirrored in the current diagnostic manuals. However, considering the frequency and clinical relevance of sleep disturbances, and interpreting this in the context of the aetiopathogenetic hypothesis of disturbed circadian rhythm, sleep disorders can be interpreted as a core symptom in another sense. The same might be true for anxious symptoms, given the high neurogenetic association of depressive and anxious symptoms.
Agomelatine has demonstrated powerful antidepressive efficacy, amongst others in terms of improvement of depressive mood and in terms of remission. According to its neurobiological mood of action, agomelatine has a special efficacy focus on disturbances of circadian rhythms and demonstrates clinical efficacy in this respect. Given the high frequency of anxious symptoms in depression and the comorbidity between depression and anxiety disorder, the efficacy of agomelatine in anxious symptoms also seems to be a beneficial aspect of the efficacy profile.
Taken together, these findings show that agomelatine qualifies as an efficient option in the treatment of depression based on its broad efficacy on the full spectrum of depressive symptoms, including those occurring early as well as those that tend to persist late over the course of the disorder.