Comparison
of the antidepressant efficacy of the SNRI,
milnacipran, and the SSRI, fluvoxamine, in
patients with major depression.
A
recent Japanese study has compared the
effectiveness of the serotonin and noradrenaline
reuptake inhibitor (SNRI), milnacipran, and the
selective serotonin reuptake inhibitor (SSRI),
fluvoxamine.
The outpatients with major depression according
to the DSM-IV were randomly assigned to receive
milnacipran (102 subjects) or fluvoxamine (90
subjects) in an open naturalistic trial.
Although no overall significant difference in
the change of 17-item Hamilton Depression Rating
Scale (HDRS) total score between baseline and
end-point was found between the two groups, a
significantly (p=0.046) greater number of
responders (more than 50% decrease in total HDRS
score) was obtained with milnacipran (68.9%)than
with fluvoxamine (46.2%) in severely depressed
patients (initial HDRS score greater than 19
points). In addition a better response for the
agitation and insomnia factors was found in the
milnacipran group. No significant difference in
adverse events was recorded between the two
groups. However, there was a trend towards more
upper digestive tract symptoms (such as
nausea)with fluvoxamine and more urinary
complications with milnacipran.
These results support previous data indicating
that SNRIs are preferred to SSRIs in more
severely depressed outpatients, and particularly
for those with agitation and insomnia. Int
Clin Psychopharmacol 17: 53-58, 2002