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Differential effects of milnacipran and fluvoxamine,
especially in patients with severe depression and agitated depression: a
case-control study.
Fukuchi T, Kanemoto K.
Fukui Clinic,
Aichi, Japan.
Int Clin Psychopharmacol. 2002 Mar;17(2):53-8.
Abstract
We attempted to compare the
antidepressant efficacy of milnacipran and fluvoxamine in 202 outpatients
with major depression, using the 17-item Hamilton Depression Rating Scale
(HDRS). Special attention was paid to the difference of responsiveness as
a function of the severity of depression and individual HDRS factors. As a
result, while no significant difference between the treatment groups was
found overall, a positive response (50% or more decrease in total score
from the baseline) was recorded significantly more often with milnacipran
than fluvoxamine recipients whose baseline HDRS total score was greater
than 19 points. Furthermore, there was a significant difference of
response for the 'agitation' and 'insomnia' factors in favour of
milnacipran. In both treatment groups, the incidence of adverse events,
characteristic of tricyclic antidepressants such as dry mouth,
constipation, somnolence and postural hypotension, was low. While
complaints concerning the upper intestinal tract, such as epigastric
distress, were predominant in the fluvoxamine group, urological
complications and palpitations were reported only in the milnacipran
group. In conclusion, we suggest that milnacipran is preferred to
selective serotonin reuptake inhibitors for the treatment of depressed
patients with agitation as well as severely depressed patients.
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