Antidepressant efficacy and tolerability of milnacipran, a dual serotonin and noradrenaline reuptake inhibitor: a comparison with fluvoxamine

Abstract

The antidepressant efficacy and tolerability of milnacipran, a dual action serotonin-noradrenaline reuptake inhibitor, were compared with those of the selective serotonin reuptake inhibitor, fluvoxamine, in 113 patients with moderate to severe major depression. Treatment with milnacipran, 50 mg b.d. for 6 weeks, produced a significantly greater reduction in Montgomery-Asberg Depression Rating Scale (MADRS) scores than fluvoxamine, 100 mg b.d. (P = 0.007; 65.4% versus 49.9%, respectively); significantly greater decreases were also seen on days 7 (P = 0.04) and 28 (P = 0.03). The response rate (the proportion of patients showing a decrease in MADRS scores of at least 50%) was 78.9% in patients receiving milnacipran, compared with 60.7% in fluvoxamine-treated patients (P = 0.04). Milnacipran also produced greater improvements in 24-item Hamilton Depression Rating Scale scores (P = 0.05). On the Clinical Global Impression Improvement scale, 77.2% of milnacipran-treated patients were rated as considerably or markedly improved, compared with 60.7% of patients receiving fluvoxamine (P = 0.06 chi-squared). Both treatments were well tolerated; the only significant difference between the two groups was a higher incidence of tremor and drowsiness in patients treated with fluvoxamine. It is concluded that milnacipran may offer some advantages over selective serotonin reuptake inhibitors, such as fluvoxamine, in the treatment of moderate to severe major depression.

Tentativa de suicídio com milnaciprano: relato de caso

“…As 4 with other SNRI, the two most common side effects of this medication are dysuria and nausea, yet this patient presented nausea and emesis. 4,7 In accordance with other norephinephrine reuptake inhibitors, the administration of high dosages of milnacipran has been reported to increased blood pressure, 7-9 which did not occur in this case. This could be attributed to the patient's emesis and the prompt medical attention.…”

“…It has been observed to have a similar antidepressant efficacy to tricyclic antidepressants (TCA), such as amitriptiline and imipramine, as well as to selective serotonin reuptake inhibitors (SSRI), such as fluvoxamine and fluoxetine. [1][2][3][4][5] Since milnacipran has only recently been introduced to the Colombian market, it has been little reported in terms of its side effects. 1,5 More importantly, no data about attempted suicide by overdose has been found.…”

Antidepressants are selective serotonin neuronal reuptake inhibitors: 40-year history

“…В 2001 г. во Франции были опубликованы результаты исследования эффективности этих антидепрессантов у 113 больных де-прессией средней и тяжелой степени. Они свидетельствова-ли, что терапия милнаципраном более эффективна, чем ле-чение флувоксамином [25]. В этом же году обследование 159 больных депрессией в Японии показало, что применение флувоксамина у больных моложе 49 лет более эффективно, чем использование милнаципрана [26].…”

A eficácia do milnaciprano em pacientes ambulatoriais com transtorno depressivo maior não respondedores ao tratamento com ISRSs: um estudo aberto de 12 semanas

“…There are at least two reasons why a clinician thinks about using a dual action antidepressant after a SSRI failed. First, it is based on the idea that an antidepressant that has a larger spectrum of action (i.e., that simultaneously enhance both serotoninergic as well as noradrenergic systems) would be more effective than a "single" system action [9][10][11][12][13] . Second is that after a failure for an antidepressant it is generally recommended to change for a drug from another class with a different mechanism of action 14 .…”

“…Most of them show no difference in efficacy [15][16][17][18] . One study show an SSRI (fluoxetine) with more efficacy than minalcipran 19 , while another the opposite 11 . A recent meta-analysis 20 concluded that milnacipran and SSRIs do not differ with respect to the overall efficacy in the treatment of MDD.…”