Effects of agomelatine and mirtazapine on sleep disturbances in major depressive disorder: evidence from polysomnographic and resting-state functional connectivity analyses

Abstract

To investigate effects of agomelatine and mirtazapine on sleep disturbances in patients with major depressive disorder. A total of 30 depressed patients with sleep disturbances, 27 of which completed the study, took agomelatine or mirtazapine for 8 weeks. Subjective scales were administered, and polysomnography was performed at baseline and at the end of week 1 and 8. Functional magnetic resonance imaging was performed at baseline and at the end of week 8. Compared with baseline, scores on the Hamilton Depression Scale, Hamilton Anxiety Scale, Pittsburgh Sleep Quality Index, Sleep Dysfunction Rating Scale, and Insomnia Severity Index after 8 weeks of treatment significantly decreased in both groups, with no significant differences between groups, accompanied by significant increases in total sleep time, sleep efficiency, and rapid eye movement (REM) sleep and significant decrease in wake after sleep onset. Mirtazapine treatment increased N3 sleep at week 1 compared with agomelatine treatment, but this difference disappeared at week 8. The increases in the percentage and duration of N3 sleep were positively correlated with increases in connectivity between right dorsal lateral prefrontal cortex (dlPFC) and right precuneus and between left posterior cingulate cortex and right precuneus in both groups, respectively. Functional connectivity (FC) between right dlPFC and left precuneus in mirtazapine group was higher compared with agomelatine group after 8 weeks of treatment. These findings indicated that both agomelatine and mirtazapine improved sleep in depressed patients, and the effect of mirtazapine was greater than agomelatine with regard to rapidly increasing N3 sleep and gradually improving FC in the brain.

Hyperintensities of middle frontal gyrus in patients with diabetic optic neuropathy: a dynamic amplitude of low-frequency fluctuation study

“…Compared with HCs, DON patients had significant vision loss and afferent optic pathway impaired which can affect the normal lives and lead to negative emotions. Huang et al [61] showed that DR patients exhibited increased dALFF variability in some brain regions that were not observed in our study, it means the increased dALFF values of MFG_R was due to the afferent optic pathway injury in DON patients. In addition, correlation analysis revealed that anxiety and depression scores were strong negative correlation with dALFF values of the MFG_R.…”

Suvorexant and mirtazapine improve chronic pain-related changes in parameters of sleep and voluntary physical performance in mice with sciatic nerve ligation

“…On the other hand, some antidepressants that increase REM sleep are associated with nightmares and REM sleep behavior disorder as side effects [48] because nightmares are essentially a REM pathology [49]. However, there is no consistent view on the effect of mirtazapine on REM sleep, with both a report that mirtazapine increases REM sleep [50] and that it does not change [51].…”

Agomelatine for the treatment of generalized anxiety disorder: focus on its distinctive mechanism of action

“… 85 , 110 , 111 , 164 In fact, blockade of 5-HT 2C receptors likely contributes to the short-term improvement by antidepressants like trazodone and mirtazapine of sleep, although their sedative properties – due to histamine H 1 antagonism – become problematic in some patients. 48 , 165 , 166 Conversely, an influence upon sleep of agomelatine (which possesses neither affinity for H 1 receptors nor marked sedative properties) does not play a major role in its antidepressant properties. 22 , 110 , 165 , 166 Hence, to answer the question of whether – and by which mechanisms – a positive influence of agomelatine upon sleep and daily cycles putatively contributes to its relief of GAD, dedicated studies in patients will be required.…”

“… 48 , 165 , 166 Conversely, an influence upon sleep of agomelatine (which possesses neither affinity for H 1 receptors nor marked sedative properties) does not play a major role in its antidepressant properties. 22 , 110 , 165 , 166 Hence, to answer the question of whether – and by which mechanisms – a positive influence of agomelatine upon sleep and daily cycles putatively contributes to its relief of GAD, dedicated studies in patients will be required. 22 , 28 , 165 , 167 …”