When is the best time for patients with irregular schedules to take agomelatine?

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Agomelatine has resynchronizing properties and affects the inner clock. In daily practice, questions arise concerning the suitability of the use of this agent in the treatment of depression with sleeping problems in patients with irregular day and night schedules (e.g. patients whose employment involves shift work or jet lag), and the most appropriate time for administration (i.e. fixed time or bedtime) in such patients. In a case report in an outpatient clinic, one flight attendant with major depression and borderline personality disorder working on long-distance flights kept a standardized diary of sleeping habits and daytime activities during treatment with agomelatine administered at a fixed time, irrespective of the local time. She had good daytime activeness and night time sleep, and was able to fulfil her tasks at work, even if she had taken the agomelatine just before her shift started. In conclusion, agomelatine can be used in patients with irregular day-night-rhythm. It should be used at a fixed time to avoid alterations in plasma levels. Larger studies are needed to confirm these results.

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