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Milnacipran versus other antidepressive agents for depression
Atsuo Nakagawa1, Norio Watanabe, Ichiro M Omori
1Department of Psychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan, 160-8582.
The Cochrane Database of Systematic Reviews
|July 10, 2009
Summary
Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI), shows no significant difference in efficacy compared to other antidepressants. However, it may offer better tolerability than tricyclic antidepressants (TCAs), with fewer adverse events and dropouts.
Area of Science:
- Pharmacology and Psychiatry
- Clinical Trial Analysis
- Evidence-Based Medicine
Background:
- Antidepressant medications are common first-line treatments for major depression.
- Milnacipran is a dual serotonin-norepinephrine reuptake inhibitor (SNRI) used in depression care.
Purpose of the Study:
- To evaluate the efficacy, acceptability, and tolerability of milnacipran.
- To compare milnacipran against tricyclic antidepressants (TCAs), heterocyclics, SSRIs, and newer agents in acute major depression treatment.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched Cochrane Collaboration databases, drug agency trials, and ongoing trial registers.
- Included 16 RCTs (n=2277) comparing milnacipran monotherapy with active antidepressants.
Main Results:
- No statistically significant differences in efficacy, acceptability, or tolerability were found between milnacipran and other antidepressants.
- Milnacipran was associated with fewer dropouts due to adverse events compared to TCAs (OR 0.55).
- Weak evidence suggests milnacipran may cause fewer adverse events like sleepiness, dry mouth, or constipation than TCAs.
Conclusions:
- Inadequate evidence exists to definitively position milnacipran against other antidepressants for major depression efficacy, acceptability, or tolerability.
- Milnacipran shows potential advantages over TCAs regarding adverse event-related dropouts and incidence of specific side effects.
- Further research is needed on cost-effectiveness and social functioning outcomes, such as return to work.
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