2007]. There is also some evidence to suggest that agomelatine improves sleep efficiency and increases the total amount of slow wave sleep [Quera Salva et al. 2007]. It is also thought to improve ‘daytime alertness’ compared with venlafaxine [Lemoine et al. 2007]. Agomelatine has also been shown to prevent relapse at similar rates to other antidepressants [Goodwin et al.

2009]. It appears to be well tolerated, with less weight gain, sexual side effects, sleep problems and withdrawal syndrome compared with SSRIs [European Public Assessment Report; Inhibitors,research,lifescience,medical Montgomery et al. 2006; Rouillon, 2006]. There is evidence that agomelatine improves Hamilton Anxiety Rating Scale scores in SB525334 ic50 patients with generalized

anxiety disorder [Stein et al. 2008]. In patients with seasonal affective disorder, Inhibitors,research,lifescience,medical 25 mg of agomelatine over 14 weeks was associated with significant improvements in the Structured Interview Guide for the HAM-D, with a particular improvement in sleep disturbance and daytime fatigue [Pjrek et al. 2007]. Adjunctive use in patients with bipolar type 1 disorder Inhibitors,research,lifescience,medical also showed improvement in HAM-D scores [Calabrese et al. 2007] and the risk of triggering a manic switch was similar to that seen with venlafaxine [Calabrese et al. 2007]. This small study involved 21 patients with type I bipolar disorder Inhibitors,research,lifescience,medical who were prescribed concurrent mood-stabilizing agents (either lithium or valporic acid). All the patients were followed up for 6 weeks and although the preliminary findings suggest 25 mg of agomelatine is efficacious, a RCT is planned to confirm the results. Given its apparent efficacy and favourable side-effect profile, some have regarded agomelatine as an ‘innovative treatment for major depressive disorder patients offering a new approach in the management of depressed patients’ [den Boer et al. 2006]. However, most of the evidence about the efficacy and tolerability

Inhibitors,research,lifescience,medical of agomelatine as an antidepressant is derived from RCTs which are of short duration (usually 6–12 weeks). Currently there are no published retrospective, naturalistic studies involving agomelatine in clinical through practice and there are no published studies looking at combinations of agomelatine with other antidepressants. Aims We aimed to determine the tolerability and clinical effectiveness of agomelatine in unipolar depression in clinical practice. We also aimed to discern whether being refractory to previous treatment altered outcome. Method A retrospective analysis of all psychiatric contacts in a discrete geographical area in Scotland was undertaken searching the electronic records using the keyword ‘agomelatine’.