Depression is one of those conditions that’s frequently misunderstood. It’s more than just a low mood or feeling a bit down - after all we all feel like that from time to time but we’re not all suffering from depression. And it’s not something that you can simply “snap out of”. Rather depression is a serious, complicated medical condition that takes time, support and the right treatment for a recovery to be effective.

And depression can be incredibly debilitating, because it can manifest itself in so many ways that can have a serious impact not only on the sufferer but on their family, friends and work. For example sufferers may lose interest in their old lives, may withdraw from social contact, may experience eating and sleeping difficulties, and may experience more physical pain and fatigue. Indeed, depression can be so debilitating that it is the leading cause of disability for those aged 15-44 in the US. And it’s widespread too affecting around 1 in 5 people at some point in their lives. In the United States alone, more than 21 million Americans are annually affected by depression.

It’s hardly surprising therefore to find that over the years drug companies have poured millions of dollars into research in order to bring drugs to the market that can help treat this terrible condition. We’ve probably all heard of Prozac that, in the 1980’s, heralded a new approach in the treatment of depression in the form of selective serotonin reuptake inhibitors or SSRIs. SSRIs were as effective as their older forebears, the tricyclic antidepressants, but had fewer side effects.

Even today, three decades on, SSRIs still remain the treatment of choice for many but as time has passed we have come to realise that they are not the wonder drugs that they were first thought to be. Those suffering from severe forms of depression have been found to respond well to SSRIs but it is clear now that they are not as effective for those with milder forms of the illness. And even though SSRIs may have fewer side effects than tricyclic antidepressants, side effects such as sleep problems, sexual health issues, lethargy and weight gain can occur. Patients also run the risk of developing the potentially lethal complication of serotonin syndrome.

And for many, stopping antidepressants can be a battle in itself as they can be very hard to quit.

It is therefore with great anticipation that we welcome the introduction of Agomelatine - a completely new and innovative way of treating depression. Agomelatine (under the trade name Valdoxan) is what is known as a norepinephrine dopamine disinhibitor (NDDI) antidepressant. It is unique in that affects both the hormone and neurotransmitter serotonin (the target for SSRIs) and the hormone Melatonin making it the first melotanergic antidepressant.

So why is it important for an antidepressant to have an effect on melatonin as well as serotonin? To answer this we need to know a little bit about melatonin. It’s a naturally occurring hormone that is produced by the pineal gland, a small pea sized gland located in the centre of the brain but outside the blood brain barrier. Melatonin production is directly linked to light - its production is stimulated by darkness and suppressed by light which has led to it often being called the “hormone of darkness” which leads to daily variations in our circulating melatonin levels. Increasing levels of melatonin brought on by increasing darkness each evening cause us to feel drowsy and our body temperatures to be lowered. Not surprisingly, therefore, melatonin plays an important part in sleep and the regulation of our body cycles (often called circadian rhythms).

And it’s this relationship with sleep patterns and circadian rhythms that’s important when it comes to Agomelatine and the treatment of depression. People suffering from depression often have disrupted sleep patterns and circadian rhythm dysfunction. We all know that good quality sleep on a regular basis is vitally important for our overall health and well being. Disrupted, poor quality sleep and circadian rhythms that are all over the place can wreck havoc even in the healthiest of us, so it’s not hard to see why they can exacerbate a disease like depression.

Fortunately, Agomelatine is able to work quickly to regulate sleep/wake cycles and to significantly improve sleep quality in depressed patients. And, unlike so many other medications used to improve sleeping patterns and the quality of sleep, Agomelatine is able to achieve this without causing daytime drowsiness. With sleep complaints being a major symptom for so many depression sufferers, being able to successfully tackle this area without day time sedative effects, gives Agomelatine a real edge over other antidepressants.

But Agomelatine doesn’t just work to improve sleep and sleeping patterns, it is also an effective antidepressant in its own right. This is because Agomelatine is an NDDI (see above) and, therefore, acts as a 5HT2C antagonist. 5HT2C receptors are normally activated by the neurotransmitter serotonin (neurotransmitters are chemicals that act as the brain’s messenger service allowing communication between neurons). The problem is that when they are activated, 5HT2C receptors cause anxiety, social anxiety, depression, and compulsive behaviours.

Scientists now believe that a significant portion of those suffering from depression, anxiety, and social anxiety have over-active 5HT2C receptors in their brains. But, by acting as antagonist, Agomelatine blocks these receptors, which in turn lifts levels of the neurotransmitters dopamine and norepinephrine in many areas of the brain. Although exactly why increasing levels of dopamine and norepinephrine helps to alleviate depression is not yet fully understood, the result of elevating levels of these neurotransmitters helps to lift a person’s mood and, therefore, makes Agomelatine an effective antidepressant.

Finally, Agomelatine is also a useful anxiolytic medication i.e. a drug that is used for the treatment of the symptoms of anxiety.

But perhaps what makes Agomelatine even more exciting is that it appears to address two of the key problems found with other antidepressants. Many people are wary of taking antidepressants, even though they would greatly benefit themselves if they did, because they fear the side effects and/or problems with discontinuation. We have all heard tales of the side effects from medications being as bad if not worse than the depression itself or of people finding it notoriously difficult to quit taking their medications even though they are feeling much better. Agomelatine, on the other has an excellent safety profile. It appears to be remarkably well tolerated and has not been associated with side effects such as weight gain, sexual problems or sleep disturbances that seem to plague other antidepressants. Indeed, some of the patients on Agomelatine report that it gives them the best sleep that they have ever had! And as for discontinuation, stopping Agomelatine treatment does not appear to cause any of the problems associated with stopping other antidepressants even when treatment is halted abruptly.

With initial research already indicating that Agomelatine is at least as effective as existing antidepressants, with its excellent safety and tolerability record, its ability to arrest sleep problems and its ease of cessation, this remarkable medication with its own, unique pharmacological profile is forging a new way ahead in the treatment of this devastating, debilitating and, unfortunately, all too common and often misunderstood disease.