Milnacipran: a unique antidepressant?

Siegfried Kasper, Gerald PailDepartment of Psychiatry and Psychotherapy, Medical University of Vienna, AustriaAbstract: Tricyclic antidepressants (TCAs) are among the most effective antidepressants available, although their poor tolerance at usual recommended doses and toxicity in &shy;overd...

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Autores principales:	Siegfried Kasper, Gerald Pail
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2010
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/0462ca97991e4b7fa12f51c2008f3bf1
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spelling	oai:doaj.org-article:0462ca97991e4b7fa12f51c2008f3bf12021-12-02T01:23:47ZMilnacipran: a unique antidepressant?1176-63281178-2021https://doaj.org/article/0462ca97991e4b7fa12f51c2008f3bf12010-08-01T00:00:00Zhttp://www.dovepress.com/milnacipran-a-unique-antidepressant-a5112https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Siegfried Kasper, Gerald PailDepartment of Psychiatry and Psychotherapy, Medical University of Vienna, AustriaAbstract: Tricyclic antidepressants (TCAs) are among the most effective antidepressants available, although their poor tolerance at usual recommended doses and toxicity in &shy;overdose make them difficult to use. While selective serotonin reuptake inhibitors (SSRIs) are &shy;better tolerated than TCAs, they have their own specific problems, such as the aggravation of sexual dysfunction, interaction with coadministered drugs, and for many, a discontinuation syndrome. In addition, some of them appear to be less effective than TCAs in more severely depressed patients. Increasing evidence of the importance of norepinephrine in the etiology of depression has led to the development of a new generation of antidepressants, the serotonin and &shy;norepinephrine reuptake inhibitors (SNRIs). Milnacipran, one of the pioneer SNRIs, was designed from theoretic considerations to be more effective than SSRIs and better tolerated than TCAs, and with a simple pharmacokinetic profile. Milnacipran has the most balanced potency ratio for reuptake inhibition of the two neurotransmitters compared with other SNRIs (1:1.6 for milnacipran, 1:10 for duloxetine, and 1:30 for venlafaxine), and in some studies milnacipran has been shown to inhibit norepinephrine uptake with greater potency than serotonin (2.2:1). Clinical studies have shown that milnacipran has efficacy comparable with the TCAs and is superior to SSRIs in severe depression. In addition, milnacipran is well tolerated, with a low potential for pharmacokinetic drug&ndash;drug interactions. Milnacipran is a first-line therapy suitable for most depressed patients. It is frequently successful when other treatments fail for reasons of efficacy or tolerability.Keywords: milnacipran, SNRI, antidepressant efficacy, tolerability Siegfried KasperGerald PailDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2010, Iss Supplement 1, Pp 23-31 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Siegfried Kasper Gerald Pail Milnacipran: a unique antidepressant?
description	Siegfried Kasper, Gerald PailDepartment of Psychiatry and Psychotherapy, Medical University of Vienna, AustriaAbstract: Tricyclic antidepressants (TCAs) are among the most effective antidepressants available, although their poor tolerance at usual recommended doses and toxicity in &shy;overdose make them difficult to use. While selective serotonin reuptake inhibitors (SSRIs) are &shy;better tolerated than TCAs, they have their own specific problems, such as the aggravation of sexual dysfunction, interaction with coadministered drugs, and for many, a discontinuation syndrome. In addition, some of them appear to be less effective than TCAs in more severely depressed patients. Increasing evidence of the importance of norepinephrine in the etiology of depression has led to the development of a new generation of antidepressants, the serotonin and &shy;norepinephrine reuptake inhibitors (SNRIs). Milnacipran, one of the pioneer SNRIs, was designed from theoretic considerations to be more effective than SSRIs and better tolerated than TCAs, and with a simple pharmacokinetic profile. Milnacipran has the most balanced potency ratio for reuptake inhibition of the two neurotransmitters compared with other SNRIs (1:1.6 for milnacipran, 1:10 for duloxetine, and 1:30 for venlafaxine), and in some studies milnacipran has been shown to inhibit norepinephrine uptake with greater potency than serotonin (2.2:1). Clinical studies have shown that milnacipran has efficacy comparable with the TCAs and is superior to SSRIs in severe depression. In addition, milnacipran is well tolerated, with a low potential for pharmacokinetic drug&ndash;drug interactions. Milnacipran is a first-line therapy suitable for most depressed patients. It is frequently successful when other treatments fail for reasons of efficacy or tolerability.Keywords: milnacipran, SNRI, antidepressant efficacy, tolerability
format	article
author	Siegfried Kasper Gerald Pail
author_facet	Siegfried Kasper Gerald Pail
author_sort	Siegfried Kasper
title	Milnacipran: a unique antidepressant?
title_short	Milnacipran: a unique antidepressant?
title_full	Milnacipran: a unique antidepressant?
title_fullStr	Milnacipran: a unique antidepressant?
title_full_unstemmed	Milnacipran: a unique antidepressant?
title_sort	milnacipran: a unique antidepressant?
publisher	Dove Medical Press
publishDate	2010
url	https://doaj.org/article/0462ca97991e4b7fa12f51c2008f3bf1
work_keys_str_mv	AT siegfriedkasper milnacipranauniqueantidepressant AT geraldpail milnacipranauniqueantidepressant
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Milnacipran: a unique antidepressant?

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