Comparing the effectiveness of agomelatine, bupropion, and sertraline in the treatment of non-psychotic major depressive disorder: a double- blind, randomized clinical trial

Background and purpose

Major depression is a psychiatric disorder associated with a decrease in performance in personal and interpersonal relationships. Among the various treatment options for major depression, pharmacotherapy is the most common method. However, some patients do not respond adequately to first- or second-line antidepressants. Many patients discontinue their medications due to intolerable side effects, inadequate responses, and the persistence of symptoms. In this study, the efficacy of agomelatine was compared against sertraline and bupropion.

Research method

A double-blind, randomized clinical trial was conducted on 90 patients diagnosed with major depressive disorder according to DSM-5, who were referred to Shahid Yahiinejad Hospital in Babol, Iran. Patients were assigned to three groups using a random block design. The agomelatine group initially received 25 mg of the drug daily for two weeks. Patients who did not show improvement with 25 mg per day were increased to 50 mg per day. The sertraline group received 50 mg of the drug daily. The bupropion group received 75 mg of the drug per day. Initial drug response and side effects were assessed in the second week, while secondary responses and more complete responses to treatment were evaluated in weeks 4 and 8. The Hamilton Depression Rating Scale was used to measure response and remission in weeks 2, 4, and 8.

Findings

The average age of participants was 39.49 years, with a standard deviation of 10.55. Side effects in patients treated with agomelatine were generally fewer than in the other two groups. The association between different drugs and side effects such as decreased sexual desire, nausea, headache, anxiety, drowsiness, palpitations, and restlessness was significant (p < 0.05). However, this relationship was not significant for other complications (p > 0.05). The depression scores during the follow-up visits showed a decreasing trend across all patients, regardless of the drug group. There was a significant difference in the average depression scores between the agomelatine, sertraline, and bupropion groups in the second (p = 0.002), fourth (p = 0.004), and eighth (p = 0.003) weeks.

Conclusion

The results of the study demonstrated that the use of agomelatine in patients with non-psychotic major depressive disorder was as effective as sertraline and bupropion in reducing depression scores. Additionally, the side effects associated with agomelatine were less frequently reported compared to the other routine antidepressant drugs.