Source: Neuron  |  Posted 9 years ago

Milnacipran has been shown equally effective as imipramine for the treatment of major depression as well as having a far superior tolerance.

French clinicians think "milnacipran constitutes an important new treatment option in major depression" following a multi-center double-blind, randomised trial among 109 patients. It was led by clinicians at Centre Hospitalier Intercommunal Poissy St-Germain-En-Laye, Centre Hospitalier Emile Roux, Eaubonne, and Clinical Institut de Recherche Pierre Fabre, Boulogne, France.

They compared the efficacy and tolerance of milnacipran, a novel selective serotonin and noradrenaline reuptake inhibitor, with mipramine. All of the patients had a major depression as measured by two established ratting scales. They underwent a three to seven day washout before treatment began over a two-week period in hospital.

Over a total of six weeks clinicians assigned 53 patients to receive milnacipran at 50 mg twice a day, and 56 patients to receive imipramine at 75 mg twice a day. Concomitant psychiatric medication was limited to lorazepam, cyamemazine, chloral hydrate and long-term uncomplicated lithium therapy.

The rating scales, as well as a visual analogue scale and global evaluation, showed both agents to be highly effective among the treatment groups. However, the clinicians found that tolerance assessed by physiological and biochemical examinations with routine inventory, and spontaneous report of adverse events, demonstrated a clear advantage for milnacipran.

"The incidence of anticholinergic events with milnacipran was about half that with imipramine and the overall incidence of adverse events by either reporting method was markedly lower with milnacipran than with imipramine," the clinicians declare. In addition, the patient drop-out rate was double that with imipramine compared with the drop out among patients receiving milnacipran.