Milnacipran
is effective in fibromyalgia syndrome (FMS)
associated with depression
Fibromyalgia
syndrome (FMS) is a chronic disease of
widespread and debilitating pain, occurring
frequently in the general population where it is
often co-morbid with other rheumatoid and pain
disorders, and psychiatric diseases such as
anxiety and depression. No specific drug has
been approved for FMS treatment. However
antidepressants, especially tricyclics, appear
to be effective. The effectiveness of the SNRI,
milnacipran, has been evaluated in patients with
FMS and co-morbid depression.
Twenty patients with FMS and co-morbid
depressive symptoms were enrolled in an open
label trial and treated with milnacipran at the
initial dose of 30 mg/day (bid). If necessary,
the dose was increased to 100 mg/day (bid). The
final mean daily doseof milnacipran at the end
of the study was 59.7mg. The mean duration of
FMS at the beginning of the study was 54.1
years. Patient evaluation took place at baseline
and after 4, 8 and 12 weeks. Pain was assessed
using pain visual analog scale (pVAS) and the
face scale, global symptomatology by global
visual analog scale (gVAS), and severity of
depression with the Zung self rating scale.
Eighteen patients completed 12 weeks of
treatment. Two patients withdrew because of
nausea. Pain and general condition significantly
improved from week 8, whereas depression
improved from week 4. In five patients the
decrease of pain was greater than 50% at the end
of the study. Post-hoc analysis indicated that
pain and global symptoms were the most improved
in the 11 patients who were no longer depressed.
In addition no adverse effects were
reported.
Although this study is a small open trial it
clearly suggests the efficacy and safety of
milnacipran in treating FMS, particularly if it
is accompanied by depressive symptoms. Although
venlafaxine has previously been shown to be
effective in FMS this is the first report of
this activity for milnacipran. Nagaoka
S, Ohno M, Sekiguchi A. An open-label clinical
trial of milnacipran in fibromyalgia syndrome
with co-morbid depressive symptoms. Int J
Psychiat Clin Pract 8: 47-51, 2004