Clinical utility of milnacipran in comparison with other antidepressants

The utility of milnacipran in the treatment of major depression has been the subject of an extensive clinical development programme. Comparative studies with tricyclic antidepressant drugs have demonstrated equivalent efficacy, with improved tolerability, in particular with respect to autonomic effects. In comparison with selective serotonin reuptake inhibitors (SSRIs), milnacipran shows similar good tolerability. It appears superior to such drugs in the treatment of severe depression, but equivalent to them for mild to moderate depression. In contrast to treatment with SSRIs, treatment response to milnacipran appears to be associated with the degree of psychomotor retardation. The good tolerability of milnacipran makes it safe in overdose. This drug also has a beneficial effect on suicidal ideation. Maintenance therapy with milnacipran has been demonstrated to reduce the recurrence of depressive episodes.