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BENEFICIOS TERAPEUTICOS DE LA AGOMELATINA EN PACIENTES CON DEPRESION
(especial para SIIC © Derechos reservados)
La medici贸n del nivel de melatonina no es un biomarcador 煤til de depresi贸n. No se cuenta con fundamentos adecuados para indicar la existencia de un subtipo de depresi贸n asociado con un nivel bajo de melatonina. Los perfiles nocturnos de melatonina pueden ser 煤tiles para identificar los pacientes con anormalidades de las fases circadianas. El entrenamiento del sistema circadiano puede ser de ayuda para la recuperaci贸n de los pacientes con episodios de trastorno depresivo mayor. No obstante, la melatonina y los agonistas melatonin茅rgicos no son 煤tiles para la monoterapia de los pacientes con trastorno depresivo mayor. Los beneficios terap茅uticos de la agomelatina en pacientes con depresi贸n se deben al agonismo melatonin茅rgico y al antagonismo 5HT2C.
Autor:
Trevor Ronald Norman
Columnista Experto de SIIC

Institución:
University of Melbourne


Artículos publicados por Trevor Ronald Norman
Recepción del artículo
23 de Septiembre, 2016
Aprobación
12 de Octubre, 2016
Primera edición
12 de Junio, 2017
Segunda edición, ampliada y corregida
27 de Julio, 2017
doi: http://dx.doi.org/10.21840/siic/147097

Resumen
Introducci贸n: Los trastornos de los ritmos estacionales y circadianos en pacientes con melancol铆a se describen desde la antig眉edad. Sin embargo, la caracterizaci贸n fisiol贸gica de los ritmos circadianos end贸genos fue posible a partir de la era moderna. Las caracter铆sticas fenomenol贸gicas de la depresi贸n mayor, as铆 como la evaluaci贸n de los ritmos circadianos, brindan fundamentos para la elaboraci贸n de una hip贸tesis etiol贸gica circadiana de la enfermedad. La l贸gica sugerir铆a que la adecuaci贸n de los ritmos circadianos mediante estrategias farmacol贸gicas o fisiol贸gicas resultar铆a en el alivio de los s铆ntomas de la enfermedad. M茅todos: El presente estudio eval煤a, en forma cr铆tica, en qu茅 medida los cambios de los ritmos circadianos permiten modificar los s铆ntomas de depresi贸n, de acuerdo con la informaci贸n publicada. Resultados: La melatonina puede adelantar o retrasar los ritmos circadianos seg煤n el momento de administraci贸n. Su uso en presencia de trastornos del estado de 谩nimo es analizado en forma breve. La creaci贸n de un agonista farmacol贸gico de la melatonina, la agomelatina, brind贸 una forma alternativa de manipulaci贸n circadiana en pacientes con depresi贸n mayor. Tambi茅n se presenta una evaluaci贸n breve de los estudios cl铆nicos sobre su eficacia en pacientes con depresi贸n mayor. Los efectos terap茅uticos de esta droga reflejan en qu茅 medida puede considerarse el surgimiento de la depresi贸n sobre la base exclusiva de la presencia de trastornos circadianos. La realizaci贸n de estudios en modelos precl铆nicos brind贸 informaci贸n sobre las acciones adicionales de la medicaci贸n que tambi茅n podr铆an contribuir con sus efectos antidepresivos. Conclusiones: Si bien los datos disponibles coinciden con la idea de que el reentrenamiento de los ritmos circadianos es necesario para la recuperaci贸n de los pacientes con depresi贸n, esto no constituir铆a una condici贸n suficiente.

Palabras clave
melatonina, agomelatina, ritmo circadiano, agonistas de la melatonina, antidepresivos


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Abstract
Introduction: Alterations of seasonal and circadian rhythms in melancholia have been described since antiquity. Only since the modern era has it been possible to physiologically characterise endogenous circadian rhythms. Phenomenological features of major depression, as well as measurement of endocrine rhythms, provide support for a circadian aetiological hypothesis of the disorder. Logic would suggest that adjustment of circadian rhythms, either pharmacologically or physiologically, should result in the alleviation of the symptoms of the disorder. Methods: This paper critically assesses the extent to which known circadian shifting modalities can modify the symptoms of depression based on published data. Results: Melatonin is capable of either advancing or delaying circadian rhythms depending on the timing of its' administration. The use in mood disorders is briefly reviewed. Development of the pharmacological melatonin agonist, agomelatine, has provided an alternative means of circadian manipulation in major depression. A brief overview of clinical studies evaluating its efficacy in major depression is also presented. At the heart of the therapeutic effects of this medication is the extent to which it can be considered to arise from circadian alterations alone. Studies in pre-clinical models have provided an insight into additional actions of the medication which might also contribute to its' antidepressant effects. Conclusions: While the evidence supports the notion that re-entrainment of the circadian rhythm is necessary for recovery from depression, it may not be a sufficient condition.

Key words
melatonin, agomelatine, circadian rhythm, melatonin agonist, antidepressant


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Especialidades
Principal: Farmacolog铆aSalud Mental
  Relacionadas: Atenci贸n PrimariaBioqu铆micaFarmacolog铆aMedicina Farmac茅uticaMedicina Familiar

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Trevor Ronald Norman, Heidelberg, Australia
Bibliografía del artículo
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