MILNACIPRAN, A NEW SEROTONIN AND NORADRENALINE REUPTAKE INHIBITOR - AN OVERVIEW OF ITS ANTIDEPRESSANT ACTIVITY AND CLINICAL TOLERABILITY

Milnacipran (Ixel(R)) is a new antidepressant with essentially equal p otency for inhibiting the reuptake of both serotonin and noradrenaline , with no affinity for any neurotransmitter receptor studied. A review of the studies comparing milnacipran, placebo and active comparator a ntidepressants provides clear-cut evidence of its efficacy in both sev ere and moderate depression in hospitalized and community settings. Me ta-analyses of the original data of controlled trials involving 1032 p atients, comparing milnacipran with imipramine or selective serotonin reuptake inhibitors (SSRIs), show that milnacipran provides antidepres sant efficacy similar to that of imipramine and significantly superior to that of the SSRIs. An analysis of a database of over 3300 patients shows that both the general and cardiovascular tolerability of milnac ipran are superior to those of the tricyclic antidepressants (TCAs) wi th fewer cholinergic side-effects. The tolerability of milnacipran was comparable to that of the SSRIs, with a higher incidence of dysuria w ith milnacipran, and a higher frequency of nausea and anxiety with the SSRIs. Milnacipran is a new therapeutic option in depression, which o ffers a clinical efficacy in the range of the TCAs combined with a tol erability equivalent to that of the SSRIs.