There was also some weak evidence to suggest that patients taking milnacipran experienced fewer adverse events of sleepiness/ drowsiness , dry mouth or constipation compared with TCAs .
AUTHORS ' CONCLUSIONS Currently , there is inadequate evidence to conclude whether milnacipran is superior , inferior or the same as other antidepressive agents in terms of efficacy , acceptability and tolerability in the acute phase treatment of major depression .
However , there is some evidence in favour of milnacipran over TCAs in terms of dropouts due to adverse events ( acceptability ) and the rates of experiencing adverse events ( tolerability ) .
Further study is needed to answer whether milnacipran would be the better choice of antidepressant for acute major depression
BACKGROUND Although pharmacological and psychological interventions are both effective for major depression , antidepressant drugs are frequently used as first-line treatment in primary and secondary care setting s. Milnacipran , a dual serotonin-norepinephrine reuptake inhibitor ( SNRI ) , is one of the antidepressant drugs that clinicians use for routine depression care .
OBJECTIVES To assess the evidence for the efficacy , acceptability and tolerability of milnacipran in comparison with tricyclic antidepressants ( TCAs ) , heterocyclics , SSRIs and other newer antidepressive agents in the acute-phase treatment of major depression .
Interest of a loading dose of milnacipran in endogenous depressive inpatients: Comparison with the standard regimen and with fluvoxamine
A multicenter controlled study was design ed to test the hypothesis that a loading dose of an antidepressant could shorten the latency of its clinical efficacy .  Three parallel groups of about 40 endogenous depressive in patients received either a loading dose of milnacipran ( 300 mg daily for 2 weeks and 150 mg daily during the 2 following weeks ) , the st and ard regimen of milnacipran in severe depression ( 200 mg daily for 4 weeks ) , or fluvoxamine ( 200 mg daily for 4 weeks ) . The duration of the study was 4 weeks , with assessment s at baseline and after 4 , 9 , 14 , 21 , and 28 days of therapy by means of Montgomery and Asberg depression scale ( MADS ) , the Hamilton depression scale , the Clinical Global Impressions ( CGI ) , and a checklist of symptoms and side-effects . Results showed very similar evolution in the 3 treatment groups . In addition , the level of side-effects did not exhibit significant differences among the treatment groups , except for excitement-nervousness and akathisia which were more frequently reported with fluvoxamine . These results do not support the usefulness of a loading dose of an antidepressant such as milnacipran . They demonstrate however that milnacipran can be given at a 300 mg daily dose from the very first day of treatment with an excellent tolerance
There was also some weak evidence to suggest that patients taking milnacipran experienced fewer adverse events of sleepiness/ drowsiness , dry mouth or constipation compared with TCAs .
AUTHORS ' CONCLUSIONS Currently , there is inadequate evidence to conclude whether milnacipran is superior , inferior or the same as other antidepressive agents in terms of efficacy , acceptability and tolerability in the acute phase treatment of major depression .
However , there is some evidence in favour of milnacipran over TCAs in terms of dropouts due to adverse events ( acceptability ) and the rates of experiencing adverse events ( tolerability ) .
Further study is needed to answer whether milnacipran would be the better choice of antidepressant for acute major depression
BACKGROUND Although pharmacological and psychological interventions are both effective for major depression , antidepressant drugs are frequently used as first-line treatment in primary and secondary care setting s. Milnacipran , a dual serotonin-norepinephrine reuptake inhibitor ( SNRI ) , is one of the antidepressant drugs that clinicians use for routine depression care .
OBJECTIVES To assess the evidence for the efficacy , acceptability and tolerability of milnacipran in comparison with tricyclic antidepressants ( TCAs ) , heterocyclics , SSRIs and other newer antidepressive agents in the acute-phase treatment of major depression .