The homogeneity of the efficacy results across the studies was assessed using descriptive statistics and a test of homogeneity. This benign tolerability profile has also been confirmed in a naturalistic study of more than 3300 patients (Laux, 2012). The antidepressant agomelatine has been used in Europe for several years. eine Kombination von Escitalopram und Agomelatin ist prinzipiell möglich. Ein Absetzen wäre in der Regel besonders folgenreich für den Patienten. (4) Holt, S., Schmiedl, S., Thürmann, P. A., Potentially inappropriate medication in the elderly – PRISCUS list. The liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured three times in all inpatients during the study, and no changes in liver enzymes were observed.25. Agomelatine augmentation in obsessive compulsive disorder: a preliminary report, Agomelatine and duloxetine synergistically modulates apoptotic pathway by inhibiting oxidative stress triggered intracellular calcium entry in neuronal PC12 cells: role of TRPM2 and voltage-gated calcium channels, The antidepressant agomelatine in daily practice: results of the non-interventional study VIVALDI, AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: update 2011, Drug therapy of depression and anxiety disorders, Goodman and Gilman’s pharmacological basis of therapy, A systematic review of agomelatine-induced liver injury, Safety and tolerability of agomelatine: focus on hepatotoxicity, Drug-induced liver injury during antidepressant treatment: results of AMSP, a drug surveillance program, Antidepressant-induced liver injury: a review for clinicians. Tipps für die Apothekenpraxis: Klagen Patienten unter entsprechender Medikation über Symptome wie Unruhe, Agitiertheit oder Muskelkrämpfe, muss an ein beginnendes Serotonin-Syndrom gedacht werden. Hierunter befinden sich auch neun Antipsychotika und Antidepressiva sowie mehrere Benzodiazepine. MDD is a dangerous and disabling disorder and is one of the leading causes of disability worldwide (Murray and Lopez, 1997; Lopez et al., 2006; Wittchen et al., 2011). Tipps für die Apothekenpraxis: QT-Zeit-Verlängerungen als Nebenwirkung sind dosisabhängig und sprechen häufig auf eine Dosisreduktion an. (3) Prax, K., et al., Aktuelles Update der Beers-Kriterien: Deutsche Übersetzung und Adaption an den deutschen Arzneimittelmarkt. The present study compared the efficacy of agomelatine and sertraline in the treatment of symptoms of depression/anxiety, diabetes self-care and metabolic control in a sample of depressed patients with non-optimally controlled type 2 diabetes mellitus (DM). Bei Clozapin als relativ toxischer Substanz mit eng umgrenzter therapeutischer Breite können bei Kombination mit dem Antidepressivum Fluvoxamin stark erhöhte Plasmaspiegel (Faktor 10 und mehr) auftreten. Agomelatine was also successfully combined with bupropion to treat severe depression resistant to previous treatment with SSRI and SNRI. However, the present studies were very similar in design, with the same primary efficacy scale and analysis, and were deemed to be a valid base for comparison of relative efficacy. Frauen, die Lamotrigin und die Pille einnehmen, müssen wissen, dass dies die kontrazeptive Sicherheit vermindern kann.  |  Über uns Bei Agomelatin handelt es sich um ein metabolisch stabiles Analogon des Melatonins mit hoher Affinität zu den Melatonin-Rezeptoren. Dies kann in der Therapie zur Folge haben, dass bei Gabe des Enzyminduktors Carbamazepin Patienten überhaupt keine klinisch ausreichenden Quetiapin-Plasmaspiegel aufbauen können. A systematic, updated review on the antidepressant agomelatine focusing on its melatonergic modulation, Agomelatine: a novel mechanism of antidepressant action involving the melatonergic and the serotonergic system, Agomelatine in the treatment of major depressive disorder: an assessment of benefits and risks. Psychopharmakotherapie 20 (2013) 148–157. Aus diesen Gründen sollte der Apotheker den Patienten nicht pauschal und ungeprüft über die potenzielle Gefährlichkeit seiner Medikation informieren, sondern stets den individuellen Fall beachten. Meta-analysis of the comparator studies is a useful way to determine the relative efficacy of an antidepressant and the results of the present analysis show that agomelatine has significantly better efficacy compared with a range of accepted and widely used antidepressants. Successful use of agomelatine and venlafaxine combination in major depression. The present analysis also excluded studies where the primary aim was a comparison with placebo and where a comparator was included in a placebo-controlled study as a check on assay sensitivity. There was a significant difference between the HAM-D17 total scores, with a greater reduction in score with agomelatine than with SSRI/SNRI [E(SE), 0.86 (0.35), 95% confidence interval 0.18–1.53, P=0.013]. Billioti de Gage S, Collin C, Le-Tri T, et al. 2011;72:464–472, Lemoine P, Guilleminault C, Alvarez E. Improvement in subjective sleep in major depressive disorder with a novel, Licht RW, Qvitzau S. Treatment strategies in patients with major depression not responding to first-line, Loo H, Hale A, D’haenen H. Determination of the dose of, Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. The cumulative incidence of withdrawals for adverse events is shown in Fig. Positive results from case reports or open-label studies describing the efficacy and safety of agomelatine in combination with other antidepressant drugs need to be confirmed by conducting randomized double-blinded clinical trials. Helfen Sie mit Ihrer Bewertung: Ja, dieses Thema ist hilfreich! The population was typical of a depressed population (mean HAM-D17 total score 26.9±3.0) and a mean of 2.9 previous depressive episodes, including the current one, which had a duration of ∼4.3 months. J Clin Psychiatry. das escitalopram morgens und das agomelatin Abends. Springer, 3. i.R. The incidence of major depression and anxiety disorders have unfortunately increased in modern Western society. Even with many antidepressant and anxiolytic drugs available on the market, there are still patients who do not respond well to the standard first or second line treatments for affective or anxiety disorders. Please enable it to take advantage of the complete set of features! Inevitably, there is an increased risk of potential errors and misleading results. Dabei ist ­Polypharmazie eher die Regel als die Ausnahme. Vier Beispiele für sinnvolle und erwünschte Kombinationen (1): • Die Augmentation eines Antidepressivums mit einem Antipsychotikum der zweiten Generation kann zu einer deutlichen Zustandsverbesserung führen. Dieses kann – ohne medizinische Intervention – schwere klinische Symptome auslösen und lebensbedrohlich sein. Risiken & Nebenwirkungen. The significant advantage of agomelatine versus comparators of 5% in responder rates is consistent with the advantage in responders of 4.2% on the basis of the Montgomery–Asberg Depression Rating Scale (MADRS) reported for escitalopram, which is claimed to be a superior antidepressant (Kennedy et al., 2006). Agomelatine did not seem to provide a significant advantage in efficacy over other antidepressive agents for the acute-phase treatment of major depression. Foto: Fotolia/aytuncoylum. Bei Kombination von drei anticholinergen Medikamenten soll sich das Delir-Risiko um den Faktor 10 erhöhen! An overview of the biotransformation enzymes involved in the metabolism of antidepressants that were used together with agomelatine is set out in Table 6. eCollection 2015. Diese können eine verminderte renale Lithium-Clearance bewirken und dadurch zu einem erhöhten Lithiumspiegel und gesteigerter Lithium-Toxizität führen. Received 2018 Jun 29; Accepted 2019 May 10. Federal government websites often end in .gov or .mil. Psychopharmaka gehören zu den am ­meisten verschriebenen Medikamenten überhaupt. Unable to load your collection due to an error, Unable to load your delegates due to an error. There have also been two published case reports about the concomitant use of duloxetine and agomelatine which were not efficacious. Insbesondere die häufig praktizierte gemeinsame Gabe von Antipsychotika und Antidepressiva ist nicht selten mit kardialen Risiken verbunden. Accessibility Montgomery SA, Nielsen RZ, Poulsen LH, et al. The significant advantage for agomelatine compared with other antidepressants fulfils the generally used criteria for establishing clinical relevance. Um sie kompetent beraten zu können, sollten ­Apotheker sinnvolle . Sie bieten meist dann einen Nutzen für den Patienten, wenn die Symptomatik nicht durch eine Monotherapie abgedeckt werden kann, zum Beispiel gedrückte Stimmung (Pharmakotherapie mit einem Antidepressivum) und wahnhaftes Schulderleben (Therapie mit einem Antipsychotikum). Der Wirkstoff schädigt womöglich die Leber. Dr Lemoine has no conflict of interest to declare. The efficacy of agomelatine has been reviewed recently (Hickie and Rogers, 2011). This may or may not be true. The https:// ensures that you are connecting to the The percentage of patients with a dose increase in each group is presented in Table 1. Neben Clozapin bergen auch andere trizyklische Substanzen wie Carbamazepin, trizyklische Antidepressiva oder Antipsychotika, zum Beispiel Levomepromazin, sowie das ältere Antidepressivum Mianserin ein höheres Risiko für eine Schädigung des weißen Blutbilds (Tabelle 2). Selten tritt während der Behandlung mit Agomelatin eine Gewichtsabnahme auf. Although a new antidepressant may be clearly effective, it is difficult to determine its relative efficacy without double-blind comparisons against the major classes of existing antidepressants such as the SSRIs and the SNRIs. 1). Data is temporarily unavailable. A number of case reports published in 2011-2016 describe the effect of agomelatine in combination with an established antidepressant, such as escitalopram, venlafaxine, duloxetine, moclobemide or bupropion. Objectives: This study aims to investigate the efficacy and safety of agomelatine, sertraline, and escitalopram for patients with senile post-stroke depression (SPSD, aged over 65 years). Tovilla-Zárate CA, Pérez-Mandujano A, Ramírez-González IR, Fresan A, Suarez-Mendez S, Martínez-Villaseñor E, Rodríguez-Sánchez E, Villar-Soto M, López-Narváez ML, González-Castro TB, Ble-Castillo JL, Juárez-Rojop IE. Efficacy of the novel, Kennedy SH, Emsley R. Placebo-controlled trial of, Kennedy SH, Andersen HF, Lam RW. A pooled analysis of six month comparative efficacy and tolerability in four randomized clinical trials: agomelatine versus escitalopram, fluoxetine, and sertraline. •Antidepressiva •Wirkweise •Substanzen und Zulassungen •Evidenz und Empfehlungen •Suizidalität •Stimmungsstabilisierende Medikamente •Substanzen und Zulassungen The protocolled analysis of efficacy was the same in the different studies and all of these constants allow some confidence in the homogeneity of the methodology used in this meta-analysis. Die Symptomatik verschwindet in der Regel innerhalb von 24 Stunden nach Absetzen der ursächlichen Medikation. Apoth. Six studies were identified versus venlafaxine, sertraline, fluoxetine, paroxetine or escitalopram. Darf ich escitalopram und agomelatin zusammen kombinieren? Significantly fewer patients withdrew because of adverse events with agomelatine (6.9%) than with SSRI/SNRI (10.7%) (P<0.001). Verl. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The method substitutes an estimate of likely response compared with a particular comparator by an indirect comparison with other comparisons in completely different studies including different populations and using different methodologies. Dies gilt natürlich nicht für eine mögliche Begleitmedikation mit Metamizol oder Carbamazepin. The particular choice of antidepressant will depend on the assessment of benefit and risk of the antidepressant, and its efficacy relative to others. • Die klinisch sehr häufige Gabe eines Benzodiazepins, insbesondere von Lorazepam, zusätzlich zu einem Antidepressivum kann zu einer raschen Kontrolle der akuten Symptomatik führen. Tzavellas E, Karaiskos D, Ilias I, et al. Zum anderen sind Clozapin-Patienten durch die sogenannte kontrollierte Anwendung in Bezug auf das Blutbild bestens überwacht. 2015 May 27;11:1307-11. doi: 10.2147/NDT.S85711. The primary depression efficacy measure was the HAM-D17 even where the primary objective of the study was pharmacodynamic or sleep parameters; the secondary scales were the CGI-I and the responder analysis, 50% or greater change from the baseline on the HAM-D17 or the CGI-I score of 1 or 2, much or very much improved. MeSH The positive results of agomelatine augmentation with other antidepressants should be confirmed through randomized, double-blind clinical trials. Dabei ist ­Polypharmazie eher die Regel als die Ausnahme. Auch eine Kombination innerhalb der Gruppe der Antipsychotika der ersten Generation oder innerhalb der zweiten Generation wird als problematisch oder sogar als irrational eingestuft. 2018.. (2) Messer, T., Schmauß, M., Polypharmazie in der Behandlung psychischer Erkrankungen. A significantly lower proportion of agomelatine patients discontinued treatment because of emergent adverse events than with SSRI/SNRI from the first week of treatment (P<0.001). However, some patients do not respond adequately to the antidepressant selected as the first or second choice.2 One reason for limited pharmacotherapy effectiveness with a selected antidepressant is that some patients are not able to rapidly make a significant change to the maladaptive behavior that was linked to the development of their depression. Two studies were excluded because the primary depression efficacy scale was not the HAM-D17 (Montgomery et al., 2004; Kennedy and Rizvi, 2010). There are now three randomized double-blind studies in which agomelatine was found to have a significantly greater reduction of the primary depression efficacy scale (HAM-D) to sertraline (Kasper et al., 2010) and fluoxetine (Hale et al., 2010), and on the Clinical Global Impression-Improvement (CGI-I) scale to venlafaxine (Lemoine et al., 2007). Before Dtsch. Agomelatine is associated with a better tolerability overall than the pool of comparators, with a lower level of adverse events than SSRI/SNRIs. 1994 Washington, DC American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. However, some patients do not respond adequately to the antidepressant selected as the first or second choice. In all six studies, these increases in transaminases were isolated, occurred mainly within the first month of treatment, were not associated with clinical signs and were, in all cases where follow-up data were available, reversible. Please try after some time. (2016) 406-420. Summary of case reports describing duloxetine augmentation with agomelatine that were not successful. Nach Erholung der Blutwerte darf man Clozapin keinesfalls erneut und alternativ auch keine trizyklischen Antipsychotika einsetzen, sondern zum Beispiel Butyrophenone wie Haloperidol. This review was published before the licensing of agomelatine as an antidepressant and before comparator studies on agomelatine were available. Novel melatonin-based therapies: potential advances in the treatment of major depression. The overall safety set included 2027 patients (1014 agomelatine, 1013 SSRI/SNRI). Demyttenaere K, Corruble E, Hale A, Quera-Salva MA, Picarel-Blanchot F, Kasper S. CNS Spectr. Häufige Nebenwirkungen des Magen-Darm-Trakts sind Bauchschmerzen, Übelkeit, Durchfall oder Verstopfung. Dtsch Arztebl Int 107 (2010) 543-551. Int Clin Psychopharmacol. 2 One reason for limited pharmacotherapy effectiveness with a selected . A total of 2034 patients were randomized (age 47.6±14.9 years; 73% women; HAM-D17 total score 26.9±3.0). The present meta-analysis includes all the studies where the protocol required a direct comparison of the relative efficacy of agomelatine and comparator antidepressant on the HAM-D17. Anticholinerge Nebenwirkungen treten vor allem unter nieder- und mittelpotenten trizyklischen Antipsychotika wie Chlorprothixen, Levomepromazin und Perazin sowie besonders ausgeprägt unter Clozapin auf (Tabelle 4). Part I: general aspects and monoamine-based strategies, Is combined treatment more effective than switching to monotherapy in patients with resistant depression? Eur Neuropsychopharmacol. According to the current summary of product characteristics for Valdoxan®, concomitant application of agomelatine with drugs that are strong inhibitors of the CYP 1A2 enzyme, for example, fluvoxamine, is contraindicated. Bei depressiven Erkrankungen sind Antidepressiva grundsätzlich wirksam. An increase of more than three times the upper limit of normal for alanine aminotransferase and/or aspartate aminotransferase was observed in 16 agomelatine-treated patients (two increases occurred after the end of the treatment period) and in five SSRI/SNRI-treated patients (two on venlafaxine, one on fluoxetine, one on paroxetine and one on escitalopram). Epub 2013 Mar 11. The response and remission rates were better in groups where agomelatine was applied either alone in group A or after switching from another antidepressant drug to agomelatine in group C, see Table 5.29 In group B, agomelatine was used in combination with other antidepressants, most frequently SSRIs, tricyclic antidepressant agents and venlafaxine.29 Remission in acute treatment of depression was achieved in two thirds of subgroup A and around half of the patients of subgroups B and C, see Table 5. official website and that any information you provide is encrypted Unser Angebot erfüllt die afgis-Transparenzkriterien. The study comparing agomelatine with escitalopram (Corruble, 2011) was a 12-week randomized double-blind study assessing the subjective sleep in MDD outpatients. Introduction. Lancet. According to these data, agomelatine deserves, on the basis of a benefit–risk analysis, to be a first-line treatment of MDD. As a library, NLM provides access to scientific literature. Efficacy of the novel antidepressant agomelatine on the circadian rest-activity cycle and depressive and anxiety symptoms in patients with major depressive disorder: a randomized, double-blind comparison with sertraline. acebo arm using antidepressant doses in the licensed range and primary evaluation on the Hamilton scale (HAM-D17). Nesterowicz M, Lauko KK, Żendzian-Piotrowska M, Ładny JR, Zalewska A, Maciejczyk M. Front Psychiatry. Remission of resistant OCD, reduction of escitalopram to 20 mg daily, Reversal of escitalopram-induced apathy during the treatment of major depression, Improvement of depression after 4 weeks of venlafaxine augmentation with agomelatine, Positive effect on OCD symptoms and depression associated with suicide ideation, Improvement of treatment-resistant depression, Akathisia induced after addition of agomelatine to duloxetine, Depression not improved; the combination resulted in excessive sweating, Improvement of treatment-resistant depression in 73.3% of patients treated with a combination of bupropion and agomelatine, compared with 53.3% of patients on monotherapy with antidepressants, Group A: agomelatine monotherapy from start of the study, Group B: agomelatine combined with other antidepressants, Group C: switch to agomelatine from another antidepressant. Baldwin DS, Florea I, Jacobsen PL, et al. A meta-analysis of randomized, placebo-controlled trials of vortioxetine for the treatment of major depressive disorder in adults, Vortioxetine: a meta-analysis of 12 short-term, randomized, placebo-controlled clinical trials for the treatment of major depressive disorder. In both studies, the primary depression efficacy scale was the HAM-D17. Agomelatine had significantly fewer discontinuations for adverse events than the comparators antidepressants at the first week of treatment and at each assessment point over the 6-week analysis (Fig. (7) Renom-Guiteras, A., Meyer, G., Thürmann, P. A., The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Tipps für die Apothekenpraxis: Von der gemeinsamen Gabe von Johanniskrautpräparaten mit anderen Antidepressiva immer abraten. The better tolerability of agomelatine, which has been reported in individual studies, is confirmed in this pooled safety analysis. Exploratory analyses of efficacy data from major depressive disorder trials submitted to the US Food and Drug Administration in support of new drug applications. Bei deutlichen Schlafstörungen hat sich die Augmentation eines Antidepressivums mit einem Antipsychotikum der zweiten Generation als zuverlässiger erwiesen. With SNRIs and SSRIs, the major adverse events are related to the serotonin reuptake inhibition, which leads to nausea and vomiting as well as nervousness and agitation. In manchen Fällen kann der Arzt eine höhere Dosis verschreiben (50 mg ), das heißt zwei Tabletten beim Zubettgehen. Viele Patienten kommen mit teilweise sehr komplexen Medikationen in die ­Apotheke. your express consent. The HAM-D17 total score at last observation was 10.6±7.3 in the agomelatine group and 11.4±8.0 in the SSRI/SNRI group (Table 3). Kombinationstherapien sind sowohl in der Therapie der Schizophrenie als auch bei uni- und bipolaren Störungen weit verbreitet und werden teilweise in den Behandlungsleitlinien empfohlen. An alternative method for examining data for the comparison of efficacy is a meta-analysis of the direct double-blind randomized head-to-head comparisons within the licensed dose range of one antidepressant with another.  |  Kontakt 1b). To further investigate the place of agomelatine in treatment relative to SSRIs and SNRIs, a meta-analysis of six short-term studies was carried out. A total of 2034 patients were randomized (age . Hier sind zu nennen: Interaktionen mit Antikoagulanzien, Immunsuppressiva, Kontrazeptiva sowie HIV-Medikamenten (Tabelle 7). Another interesting article based on the results of a clinical study was published by German researchers who had combined bupropion and agomelatine in patients suffering from severe, treatment-resistant depression. Mittel der Wahl für diesen Patientenkreis sind Melperon oder Pipamperon. Auch Kombinationen ausgewählter Antipsychotika der zweiten Generation mit Clozapin beziehungsweise Olanzapin oder mit Quetiapin haben in Studien die antipsychotische Wirkung bei Therapieresistenz erfolgreich verstärkt. > Neurologie Although less valid than direct comparisons, this can be useful. Gefährdet sind vor allem ältere Menschen, Frauen und Menschen mit vorgeschädigtem Herzen. There were no relevant differences between the group of patients receiving agomelatine and the group receiving SSRI/SNRI. Gefährlich und auch lebensbedrohlich ist die Agranulozytose mit Werten unter 500 mm³. Lancet. Bei Kombination von Arzneistoffen mit serotonergem Wirkprofil kann in seltenen Fällen ein sogenanntes Serotonin-Syndrom auftreten. The intranasal administration has enhanced both absolute bioavailability and the brain delivery of agomelatine via the direct nose to brain pathway.46 If the clinical development of medicinal products with agomelatine for intranasal application in humans was also successful we could expect that the risk of possible drug interactions between agomelatine applied intranasally and other antidepressant drugs administered perorally should then be small. 2011;378:621–631, Huf W, Kalcher K, Pail G, Friedrich ME, Filzmoser P, Kasper S. Meta-analysis: fact or fiction? The difference between treatments was analysed in the FAS and the subgroup with severe depression on parameters expressed as the last postbaseline value (6/8/12 weeks). De Berardis D, Serroni N, Marini S, et al. However, the lack of a placebo control group limits the generalisability of the findings and warrants further studies. Vierter Fallstrick: Kombination eines Psychopharmakons mit einem anderen oder mit einem Nicht-Psychopharmakon mit serotonergem Wirkungsprofil. Lower anxiety and depression scores as well as higher self-care scores were measured in the agomelatine group compared with the sertraline group after 4 months of treatment. Anticholinerge Effekte am Herzen zeigen sich vor allem mit Reflextachykardien. Valdoxan. All the studies used flexible dosing schedules with an agomelatine dosage of 25–50 mg/day administered in the evening. The disadvantage of meta-analyses is, among other considerations (Huf et al., 2011), the assumption that all studies are of equal design and scientific merit, and that they all contribute equally towards the result. Es gibt zahlreiche Fallstricke in der Kombinationstherapie mit Psychopharmaka. Aus Studien hingegen liegen keine negativen Ergebnisse vor. The full analysis set included 1997 patients (1001 agomelatine; 996 SSRI/SNRI). Within the FAS, 1556 patients had severe depression (777 agomelatine, 779 SSRI/SNRI).  |  Werbung / Mediadaten J Clin Psychiatry. Allerdings gibt es hier einige Ausnahmen. Eine Ausnahme gilt nur für Kombinationen mit Venlafaxin oder Mirtazapin. A subgroup of more severely depressed patients (defined as a baseline HAM-D17 total score of ≥25) was also analysed separately. Agomelatine treatment of major depressive disorder. Johanniskraut hat als potenter Induktor von CYP-Enzymen, insbesondere CYP3A4, ein hohes Interaktionspotenzial. Außerdem ist es ein Agonist von Melatonin-Rezeptoren (MT1/MT2), sodass es zusätzlich eine schlaffördernde . The authors achieved good remission rates in most of the patients treated with bupropion together with agomelatine compared with antidepressant monotherapy, see Table 4. Von Bedeutung ist die Problematik in erster Linie bei Clozapin (Tabelle 2). Although the main effects of treatment on final body weight and fasting plasma glucose were not significant, significantly lower final haemoglobin A1c levels were measured in the agomelatine group compared with the sertraline group. The better tolerability is also reflected in the significantly lower number of patients who withdrew from the studies because of adverse events with agomelatine than with SSRI/SNRI (P<0.001) overall and in the first week of treatment. Am besten sollte er mit dem Arzt klären, ob die Therapie unter engmaschiger Überwachung fortgesetzt werden kann. There were significant between-group differences in the rates of response on the HAM-D17 scale (P=0.012) and the CGI-I scale (P=0.032) (Table 3). In addition, duloxetine has also been reported to cause hepatotoxicity.37 Thus, agomelatine treatment with a high dose of duloxetine could increase the likelihood of drug-induced liver injury. Results: eCollection 2018. A case of successful augmentation with agomelatine for the treatment of OCD. • vorangehende Behandlungen mit mindestens zwei vergleichbaren Medikamenten keine ausreichende Besserung erbrachten oder mit intolerablen Nebenwirkungen verbunden waren. Dies kann zu einem deutlichen Anstieg der Wirkspiegel von CYP3A4-Substraten führen. Aufl. Thase ME, Mahableshwarkar AR, Dragheim M, et al. (6) Wenzel-Seifert, K., et al., Unerwünschte kardiovaskuläre Wirkungen von Psychopharmaka. Conclusion: Erster Fallstrick: Sinnvolle und erwünschte Kombinationen von Psychopharmaka werden nicht erkannt oder sogar ihre Sinnhaftigkeit in Zweifel gezogen. Vereinzelt kommt es auch zu Blasenentleerungsstörungen, die sich selten bis zum akuten Harnverhalt steigern können. Dr Quera Salva has received grant/research support from Servier; French Association Against Myopathies (AFM) and the Vinci Foundation consultant or on advisory board for Servier and Ferrer. QT-Zeit-Verlängerungen sind für etliche Medikamente bekannt, so auch für viele Psychopharmaka. It has a decided advantage in the lack of discontinuation symptoms following the abrupt withdrawal of treatment (Montgomery et al., 2004) and is associated with fewer sexual side effects than venlafaxine XR (Kennedy et al., 2008).