Antidepressant
efficacy of milnacipran in Korean depressed
patients
Some
studies have suggested that depression may have
different characteristics in different cultures,
for example between Korea and western countries.
The serotonin and noradrenaline reuptake
inhibitor (SNRI), milnacipran, is effective in
treating major depression in patients in Western
countries as well as in Japan. A study compared
the efficacy and safety of milnacipran and the
selective serotonin reuptake inhibitor (SSRI),
fluoxetine, in the treatment of major depression
in a population of Korean patients.
Adult Korean patients (n = 70, aged 17 to 70
years) diagnosed with major depressive disorder,
according to DSM-IV criteria, were recruited in
a multi-centre, randomised clinical trial. They
received milnacipran (50 mg/day increasing after
1 week to 100 mg/day) (n = 39) or fluoxetine (20
mg/day) (n = 31) for 6 weeks. Patients were
assessed on the first day prior to medication
and after 7, 14, 28 and 42 days of treatment
using the 17-item Hamilton Depression Scale
(HAM-D), Montgomery-Asberg Depression Rating
Scale (MADRS), and the Clinical Global
Impression Scale (CGI).
There was a significant decrease ( p < 0.01)
in MADRS and HAM-D17 scores during the first
week in both the milnacipran and fluoxetine
groups, which continued until the end of the
study. CGI severity score also significantly
improved for both groups. No difference was
observed between treatment groups in the
percentage of responders or patients in
remission at endpoint. Both drugs were well
tolerated. In the milnacipran group, 13 patients
of 39 (33.3%), and in the fluoxetine group, 11
patients of 31 (35.5%), reported adverse
reactions. Nausea and headache were the most
common adverse events with milnacipran, while
gastrointestinal disturbances, diarrhoea and
insomnia were those reported with fluoxetine.
Two patients (5.1%) in the milnacipran group,
and three patients (9.1%) in the fluoxetine
group withdrew because of adverse events.
These results show that effectiveness and safety
of milnacipran in Korean patients are similar to
those found in other patient populations. Since
the profile of adverse events of milnacipran and
fluoxetine is different, milnacipran could
represent an interesting and suitable
therapeutic alternative to SSRIs in some
patients. Lee
MS, Ham BJ, Kee BS, Kim JB, Yeon BK, Oh KS, Oh
BH, Lee C, Jung HY, Chee IS, Choe BM, Paik IH.
Comparison of efficacy and safety of milnacipran
and fluoxetine in Korean patients with major
depression. Curr Med Res Opin 2005,
21:1369-1375.