{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:36:23Z","timestamp":1791380183987,"version":"4.3.3"},"reference-count":8,"publisher":"MedWorks Media","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychopharmacol Bull"],"abstract":"<jats:p>Adolescent bipolar disorder (BD) is frequently accompanied by persistent sleep disturbances and depressive episodes that are resistant to standard treatments. Conventional antidepressants carry a risk of inducing mania or rapid cycling, particularly in younger patients. Agomelatine, a melatonergic agonist and selective serotonergic antagonist, addresses both circadian dysregulation and depressive symptoms through a unique mechanism that does not increase synaptic serotonin, thereby potentially minimizing the risk of mood switch. Despite its efficacy in adults, its use in adolescent BD remains largely unexplored. We present three cases of adolescents (ages 16\u201317) with bipolar depression and chronic insomnia in whom agomelatine (25\u201350 mg nightly) was added adjunctively to existing mood stabilizer or atypical antipsychotic regimens. Clinical outcomes were assessed using the Hamilton Depression Rating Scale (HDRS), Pittsburgh Sleep Quality Index (PSQI), and Young Mania Rating Scale (YMRS) over a 24-week follow-up period. All three patients demonstrated clinically meaningful improvements in both sleep quality and depressive symptomatology within the first 4\u20136 weeks, without manic switching or hepatic adverse effects. One patient successfully discontinued sedative-hypnotic use following sleep normalization. These cases suggest that adjunctive agomelatine may offer a dual benefit of sleep regulation and mood stabilization in adolescent BD, representing a promising alternative in patients who have failed or cannot tolerate conventional antidepressants. Controlled clinical trials are warranted to confirm these preliminary findings.<\/jats:p>","DOI":"10.64719\/pb.18540","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T08:56:35Z","timestamp":1780995395000},"page":"152-160","source":"Crossref","is-referenced-by-count":0,"title":["Breaking the Cycle of Insomnia and Depression: Agomelatine in Adolescent Bipolar Disorder"],"prefix":"10.64719","volume":"56","author":[{"given":"Yi\u011fit","family":"\u00d6zayd\u0131n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enes Bu\u011fra","family":"Demir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fevzi Tuna","family":"Ocako\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ey\u00fcp Sabri","family":"Ercan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54175","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Yatham LN, Kennedy SH, Parikh SV et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97\u2013170.","DOI":"10.1111\/bdi.12609"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Lewis KS, Gordon-Smith K, Forty L et al. Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender. Br J Psychiatry. 2017;211(3):169\u2013174.","DOI":"10.1192\/bjp.bp.117.202259"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Howland RH. Critical appraisal and update on the clinical utility of agomelatine, a melatonergic agonist, for the treatment of major depressive disease in adults. Neuropsychiatr Dis Treat. 2009;5:563\u2013576.","DOI":"10.2147\/NDT.S5453"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Fornaro M, McCarthy MJ, De Berardis D et al. Adjunctive agomelatine therapy in the treatment of acute bipolar II depression: a preliminary open label study. Neuropsychiatr Dis Treat. 2013;9:243\u2013251.","DOI":"10.2147\/NDT.S41557"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Falissard B, Buitelaar J, Fegert J et al. Agomelatine in children and adolescents with moderate to severe major depressive disorder: an open-label extension study. Neurosci Appl. 2022;1:100025.","DOI":"10.1016\/j.nsa.2022.100212"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Takaesu Y, Inoue Y, Murakoshi A et al. Prevalence of circadian rhythm sleep-wake disorders and associated factors in euthymic patients with bipolar disorder. PLoS One. 2016;11(7):e0159578.","DOI":"10.1371\/journal.pone.0159578"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Srinivasan V, Pandi-Perumal SR, Trakht I et al. Pathophysiology of depression: role of sleep and the melatonergic system. Psychiatry Res. 2009;165(3):201\u2013214.","DOI":"10.1016\/j.psychres.2007.11.020"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Freiesleben SD, Furczyk K. A systematic review of agomelatine-induced liver injury. J Mol Psychiatry. 2015;3(1):4.","DOI":"10.1186\/s40303-015-0011-7"}],"container-title":["Psychopharmacology Bulletin"],"original-title":[],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:37:14Z","timestamp":1791315434000},"score":1,"resource":{"primary":{"URL":"https:\/\/medworksmedia.com\/pb-article\/breaking-the-cycle-of-insomnia-and-depression-agomelatine-in-adolescent-bipolar-disorder\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":8,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6,4]]}},"URL":"https:\/\/doi.org\/10.64719\/pb.18540","relation":{},"ISSN":["2472-2448"],"issn-type":[{"value":"2472-2448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}