High-quality remission: potential benefits of the melatonergic approach for patients with major depressive disorder

Full remission of symptoms is the goal for the acute treatment of depression, because incomplete remission is associated with poor outcomes including higher risk of relapse and chronicity. The current definitions for remission (e.g. a score of </=7 on the Hamilton Depression Rating Scale), however, allow for the presence of residual symptoms of depression even if remission is attained. The focus now is on the quality of remission, that is, ensuring a minimum of such residual symptoms, because the consequences of low-quality remission also include impairment in psychosocial functioning. The most common residual symptoms are sleep disturbances, fatigue, and disinterest. Sleep-associated residual symptoms are particularly common, and are a major concern because most current treatments fail to adequately address sleep disturbances and may even aggravate them. Other side effects of current treatments, such as weight gain and sexual dysfunction, may also reduce the quality of remission. A novel approach to the treatment of depression with agomelatine, a melatonergic MT1 and MT2 receptor agonist and 5-HT2C receptor antagonist, may be an effective treatment that improves the quality of remission, as it combines good efficacy with positive effects on sleep, neutral effects on sexual function, and a favorable side effect profile.