MILNACIPRAN - THE CLINICAL PROPERTIES OF A SELECTIVE SEROTONIN AND NORADRENALINE REUPTAKE INHIBITOR (SNRI)

Milnacipran is a novel antidepressant agent which selectively inhibits the reuptake of serotonin and noradrenaline without directly affectin g postsynaptic receptor sites. The biochemical and pharmacological pro file of milnacipran suggested that the drug would be therapeutically e ffective and well tolerated. This has been borne out by the results of placebo-controlled and open label trials of the antidepressant effica cy of milnacipran, as well as of comparative trials with tricyclic ant idepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs ). The designs and results of these studies are reviewed in this paper . Milnacipran is more effective than placebo in the treatment of major depressive episodes. It is equally effective as TCAs, but better tole rated. Milnacipran appears to be superior in efficacy to the SSRIs, pa rticularly in patients with severe depression, and is equally well tol erated. The efficacy and tolerance profile of milnacipran reflects its specific pharmacological activity. The effects of milnacipran are con fined to the inhibition of serotonin and noradrenaline reuptake. There is no activity on postsynaptic receptors. Overall, milnacipran offers a beneficial combination of good efficacy and tolerability in patient s with major depression. (C) 1997 John Wiley & Sons, Ltd.