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CNS Drugs

, Volume 22, Issue 7, pp 587–602 | Cite as

Efficacy and Tolerability of Milnacipran in the Treatment of Major Depression in Comparison with Other Antidepressants

A Systematic Review and Meta-Analysis
  • Atsuo Nakagawa
  • Norio Watanabe
  • Ichiro M. Omori
  • Corrado Barbui
  • Andrea Cipriani
  • Hugh McGuire
  • Rachel Churchill
  • Toshi A. Furukawa
  • Multiple Meta-Analyses of New-Generation Antidepressants (MANGA) Study Group
Original Research Article

Abstract

Background: Milnacipran, a dual serotonin-noradrenaline reuptake inhibitor, is one of the newer antidepressants that clinicians use for the routine care of patients with major depression. We undertook a systematic review and meta-analysis of randomized controlled trials that compared the efficacy and tolerability of milnacipran with other antidepressants.

Objective: To assess the efficacy and tolerability of milnacipran in comparison with TCAs, SSRIs and other drugs in the acute phase of treatment for major depression.

Methods: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials registers, journals, conference proceedings, trial databases of the drug-approving agencies and ongoing clinical trial registers for all published and unpublished randomized controlled trials that compared the efficacy and adverse events of milnacipran versus any other antidepressant. The search was conducted in December 2006 and updated in May 2007. No language restrictions were applied. All relevant authors were contacted to supplement any incomplete reporting in the original papers.

Randomized controlled trials comparing milnacipran with any other active antidepressants as monotherapy in the acute phase of treatment for major depression were selected. Participants were aged ≥18 years, of both sexes and with a primary diagnosis of unipolar major depression. Studies were excluded when the participants had specific psychiatric and medical co-morbidities. Two independent reviewers assessed the quality of trials for inclusion, and subsequently extracted data. Disagreements were resolved by consensus. Meta-analyses were conducted for efficacy and tolerability outcomes. Sixteen randomized controlled trials (n = 2277) were included in the meta-analyses.

Results: No differences were found in achieving clinical improvement, remission or overall tolerability when comparing milnacipran with other antidepressants. However, compared with the TCAs, fewer patients taking milnacipran were early treatment withdrawals due to adverse events (number needed to harm (NNH) = 15; 95% CI 10, 48). Significantly more patients taking TCAs experienced adverse events compared with milnacipran (NNH = 4; 95% CI 3, 7).

Conclusions: The overall effectiveness and tolerability of milnacipran versus other antidepressants does not seem to differ in the acute phase of treatment for major depression. However, there is some evidence in favour of milnacipran over TCAs in terms of premature withdrawal due to adverse events and the rates of patients experiencing adverse events. Milnacipran may benefit some patient populations who experience adverse effects from other antidepressants in the acute phase of treatment for major depression.

Keywords

Fluoxetine Paroxetine Venlafaxine Remission Rate Fluvoxamine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. Dr Furukawa has received research funds and speaking fees from Asahi Kasei, Astellas, Dai-Nippon Sumitomo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Kyowa Hakko, Meiji, Nikken Kagaku, Organon, Otsuka, Pfizer and Yoshitomi. The Japanese Ministry of Education, Science and Technology, and the Japanese Ministry of Health, Labour and Welfare have also funded Dr Furukawa’s research. Dr Watanabe has received speaking fees from GlaxoSmithKline regarding evidence-based medicine. All the other authors report no financial affiliations or other relationships relevant to the subject of this study.

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Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Atsuo Nakagawa
    • 1
  • Norio Watanabe
    • 2
  • Ichiro M. Omori
    • 2
  • Corrado Barbui
    • 3
  • Andrea Cipriani
    • 3
  • Hugh McGuire
    • 4
  • Rachel Churchill
    • 4
  • Toshi A. Furukawa
    • 4
  • Multiple Meta-Analyses of New-Generation Antidepressants (MANGA) Study Group
  1. 1.Department of Neuropsychiatry, School of MedicineKeio UniversityShinjuku-ku, TokyoJapan
  2. 2.Department of Psychiatry and Cognitive-Behavioral MedicineNagoya City University Graduate School of Medical SciencesNagoyaJapan
  3. 3.Department of Medicine and Public Health, Section of Psychiatry and Clinical PsychologyUniversity of VeronaVeronaItaly
  4. 4.Cochrane Collaboration Depression, Anxiety, and Neurosis Review Group, Health Services Research DepartmentKing’s College Institute of PsychiatryLondonEngland

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