A comparative study of milnacipran and paroxetine in outpatients with major depression

Service de Psychiatrie de l'Adulte, Centre Hospitalier Universitaire St Jacques, Besançon, Cedex F-25030, France.
Journal of Affective Disorders (Impact Factor: 3.38). 01/2005; 83(2-3):233-6. DOI: 10.1016/j.jad.2004.07.002
Source: PubMed


Milnacipran is a dual-action antidepressant which inhibits both serotonin and noradrenaline reuptake with no affinity for any neurotransmitter receptor studied.
A 6-week double-blind multicentre study compared milnacipran (100 mg/day) with paroxetine (20 mg/day) in 300 outpatients with major depression. Efficacy was evaluated using HAMD17, MADRS and CGI for severity of illness and global improvement. Data were analysed on an intention to treat, last observation carried forward, basis.
Milnacipran and paroxetine were both effective and well tolerated with no significant difference in their effects. After treatment discontinuation, milnacipran was associated with significantly less emergent symptoms. Responders, at endpoint, to milnacipran had significantly greater levels of psychomotor retardation at baseline than non-responders.
The study did not include a placebo group so that it is impossible to determine absolute levels of efficacy.
Both milnacipran and paroxetine were effective and well tolerated by outpatients with major depression treated for 6 weeks. After treatment discontinuation milnacipran was associated with less emergent symptoms. Psychomotor retardation at baseline may be a predictive factor of a favourable response to milnacipran.

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Available from: Pierre Vandel, Jun 21, 2014
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    • "Sechter et al. found that baseline retardation predicted a response to milnacipran. Similarly designed studies found that PMR failed to predict a response to selective serotonin reuptake (SRRI) [90, 99]. Experimental assessments of PMR support his predictive value. "
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    ABSTRACT: Psychomotor retardation is a central feature of depression which includes motor and cognitive impairments. Effective management may be useful to improve the classification of depressive subtypes and treatment selection, as well as prediction of outcome in patients with depression. The aim of this paper was to review the current status of knowledge regarding psychomotor retardation in depression, in order to clarify its role in the diagnostic management of mood disorders. Retardation modifies all the actions of the individual, including motility, mental activity, and speech. Objective assessments can highlight the diagnostic importance of psychomotor retardation, especially in melancholic and bipolar depression. Psychomotor retardation is also related to depression severity and therapeutic change and could be considered a good criterion for the prediction of therapeutic effect. The neurobiological process underlying the inhibition of activity includes functional deficits in the prefrontal cortex and abnormalities in dopamine neurotransmission. Future investigations of psychomotor retardation should help improve the understanding of the pathophysiological mechanisms underlying mood disorders and contribute to improving their therapeutic management.
    Full-text · Article · Oct 2013
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    • "(Clerc, 2001). Comparisons of milnacipran with paroxetine have shown the 2 antidepressants have equivalent efficacy in diverse populations (Chang et al., 2008; Lee et al., 2005; Sechter et al., 2004). A meta-analysis showed that there were no differences in clinical improvement, remission, or overall tolerability when comparing milnacipran with SSRIs (Nakagawa et al., 2008). "

    Full-text · Article · Jan 2013 · Open Journal of Depression
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    • "Retardation score is the score on item 8 of the Hamilton Depression Rating Scale. Drawn from data in reference 38. "
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    ABSTRACT: Depression has a major impact on social functioning. Decreased concentration, mental and physical slowing, loss of energy, lassitude, tiredness, and reduced self-care are all symptoms related to reduced noradrenergic activity. Depressed mood; loss of interest or pleasure; sleep disturbances; and feelings of worthlessness, pessimism, and anxiety are related to reduced activity of both serotonergic and noradrenergic neurotransmission. The importance of noradrenergic neurotransmission in social functioning is supported by studies with the specific norepinephrine reuptake inhibitor reboxetine. In healthy volunteers, reboxetine increases cooperative social behavior and social drive. A placebo-controlled study in depressed patients comparing reboxetine with the selective serotonin reuptake inhibitor (SSRI) fluoxetine showed significantly greater improvement in social adaptation with reboxetine. Two recent studies have examined the effect of the serotonin and norepinephrine reuptake inhibitor milnacipran on social adaptation. A study in depressed patients found that at the end of 8 weeks of treatment with milnacipran, 42.2% patients were in remission on the Social Adaptation Self-evaluation Scale (SASS). Another study in depressed workers or homemakers found that mean depression scores were significantly reduced after 2 weeks, whereas the SASS scores were significantly improved after 4 weeks. A preliminary study comparing depressed patients treated with milnacipran or the SSRI paroxetine showed that milnacipran treatment resulted in a greater number of patients in social remission. The available data thus suggest that milnacipran may improve social functioning, with a possibly greater effect than the SSRI paroxetine. These preliminary data suggest further evaluation of social dysfunction and its treatment outcome in future trials of milnacipran.
    Full-text · Article · May 2011 · Neuropsychiatric Disease and Treatment
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