BENEFICIOS TERAPEUTICOS DE LA AGOMELATINA EN PACIENTES CON DEPRESION





BENEFICIOS TERAPEUTICOS DE LA AGOMELATINA EN PACIENTES CON DEPRESION

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La medición del nivel de melatonina no es un biomarcador útil de depresión. No se cuenta con fundamentos adecuados para indicar la existencia de un subtipo de depresión asociado con un nivel bajo de melatonina. Los perfiles nocturnos de melatonina pueden ser útiles para identificar los pacientes con anormalidades de las fases circadianas. El entrenamiento del sistema circadiano puede ser de ayuda para la recuperación de los pacientes con episodios de trastorno depresivo mayor. No obstante, la melatonina y los agonistas melatoninérgicos no son útiles para la monoterapia de los pacientes con trastorno depresivo mayor. Los beneficios terapéuticos de la agomelatina en pacientes con depresión se deben al agonismo melatoninérgico 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
7 de Junio, 2021

Resumen
Introducción: Los trastornos de los ritmos estacionales y circadianos en pacientes con melancolía se describen desde la antigüedad. Sin embargo, la caracterización fisiológica de los ritmos circadianos endógenos fue posible a partir de la era moderna. Las características fenomenológicas de la depresión mayor, así como la evaluación de los ritmos circadianos, brindan fundamentos para la elaboración de una hipótesis etiológica circadiana de la enfermedad. La lógica sugeriría que la adecuación de los ritmos circadianos mediante estrategias farmacológicas o fisiológicas resultaría en el alivio de los síntomas de la enfermedad. Métodos: El presente estudio evalúa, en forma crítica, en qué medida los cambios de los ritmos circadianos permiten modificar los síntomas de depresión, de acuerdo con la información publicada. Resultados: La melatonina puede adelantar o retrasar los ritmos circadianos según el momento de administración. Su uso en presencia de trastornos del estado de ánimo es analizado en forma breve. La creación de un agonista farmacológico de la melatonina, la agomelatina, brindó una forma alternativa de manipulación circadiana en pacientes con depresión mayor. También se presenta una evaluación breve de los estudios clínicos sobre su eficacia en pacientes con depresión mayor. Los efectos terapéuticos de esta droga reflejan en qué medida puede considerarse el surgimiento de la depresión sobre la base exclusiva de la presencia de trastornos circadianos. La realización de estudios en modelos preclínicos brindó información sobre las acciones adicionales de la medicación que también podrían 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 recuperación de los pacientes con depresión, esto no constituiría una condición 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: Farmacología, Salud Mental
Relacionadas: Atención Primaria, Bioquímica, Farmacología, Medicina Familiar, Medicina Farmacéutica



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