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A randomised, double-blind comparison of milnacipran and
imipramine in the treatment of depression.
Van Amerongen AP,
Ferrey G, Tournoux A.
Centre Medico-Psychologique Secteur VI,
Centre Hospitalier Intercommunal Poissy St-Germain-En-Laye
20, Rue Armagis, 78105 Cedex, St-Germain-En-Laye, France.
J Affect Disord. 2002 Oct;72(1):21-31.
Abstract
This multicentre, double-blind,
randomised trial in 109 patients compared the efficacy and tolerance of
the novel selective serotonin and noradrenaline reuptake inhibitor (SNRI)
antidepressant milnacipran (50 mg twice daily, n=53) with the established
tricyclic agent imipramine (75 mg twice daily, n=56) over a period of 6
weeks, in patients with major depression (Montgomery-Asberg depression
rating score (MADRS) > or =25). Initiation of antidepressant medication
was conducted during a 2-week period of hospitalisation, after a 3- to
7-day washout period. Concomitant psychiatric medication was limited to
lorazepam, cyamemazine, chloral hydrate and long-term uncomplicated
lithium therapy. Assessment for efficacy using the MADRS and Hamilton
rating scales of depression, a visual analogue scale and global evaluation
revealed both agents to be highly effective (P=0.0001) in this group of
patients. Milnacipran was found to be of similar efficacy to imipramine.
Tolerance, assessed by physiological and biochemical examinations with
routine inventory and spontaneous report of adverse events, revealed a
clear advantage for milnacipran. The incidence of anticholinergic events
with milnacipran was about half that with imipramine and the overall
incidence of adverse events by either reporting method was markedly lower
with milnacipran than with imipramine. Furthermore, the patient drop-out
rate with imipramine was double that experienced with milnacipran.
Milnacipran appears to possess equal antidepressant efficacy to imipramine
but with markedly superior tolerance. Therefore, milnacipran constitutes
an important new treatment option in major depression.
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