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 .
Controlled comparison of two different doses of milnacipran in major depressive outpatients
We compared the antidepressant efficacy and patient tolerance of two different doses of milnacipran ( 75 mg and 150 mg daily ) in 66 out patients with major depression , using the 17-item Hamilton Depression Rating Scale ( HDRS ) . Only new patients who had never experienced frank depressive episodes before , or those who had remained free from thymoregulators for more than 1 year without recurrence of depressive symptoms , were recruited . Subjects were r and omly selected to receive a daily dose of milnacipran that reached either 75 mg or 150 mg within 2–3 weeks and then remained stable over an 8-week period . The results showed a significant superiority of milnacipran at 150 mg/day over 75 mg/day at the end of the study period in both response ( 50 % or more decrease in total score from baseline , P=0.026 ) and remission ( total HDRS score lower than 7 points , P=0.034 ) . A response was recorded for 56.0 % of the patients treated with 75 mg of milnacipran and for 84.6 % of those treated with 150 mg after the 8-week study period . No significant difference was seen between the treatment groups for either individual or total incidence of adverse events . Notably , nausea and vomiting occurred most often immediately after the first visit , when subjects in both groups started with a daily dose of 50 mg . We conclude that additional comparisons between different doses of milnacipran should be performed to confirm or deny the linear dose/efficacy relationship observed in the present study
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 .