Abstract
A multicenter study compared the antidepressant efficacy and the tolerance of two doses of milnacipran (50 mg and 100 mg/day) and amitriptyline (150 mg/day) in three parallel groups of 45 major depressive inpatients defined by Research Diagnostic Criteria. After a wash-out period of 4–7 days on placebo with lorazepam and/or nitrazepam if necessary, patients were randomly assigned to a daily dose of milnacipran 50 mg, milnacipran 100 mg or amitriptyline 150 mg reached on the 5th day and then stable over a 4-week period, with weekly assessments by means of the Montgomery and Asberg depression scale, the Hamilton depression scale, the Clinical Global Impressions (CGI) and the Target Emergent Signs and Symptoms. Results showed significant superiority of both milnacipran 100 mg/day and amitriptyline over milnacipran 50 mg/day at the end of the treatment period. However, amitriptyline induced a nonsignificant trend toward more rapid improvement after 2 weeks of treatment, mainly based on items related to insomnia, supporting more sedative properties of amitriptyline as compared to milnacipran. Anticholinergic side-effects were significantly lower with milnacipran than with amitriptyline, explaining why milnacipran 100 mg exhibited at the end of the treatment period, a nonsignificantly better efficacy index on the CGI. Moreover, in contrast to milnacipran, amitriptyline was responsible for a significant decrease in blood pressure and a significant weight gain.
Similar content being viewed by others
References
Ansseau M, Ansoms C, Beckers G, Bogaert M, Botte L, De Buck R, Diricq S, Dumortier A, Jansegers E, Owieczka J, Stellamans G (1984) Double-blind clinical study comparing alprazolam and doxepin in primary unipolar depression. J Affective Disord 7:287–296
Covi L, Lipman R, McNair DM, Czerlinski T (1979) Symptomatic volunteers in multicenter drug trials. Prog Neuropsychopharmacol 3:521–533
Enelow AJ (1975) Amitriptyline in the management of depression: an overview. In: Amitriptyline in the management of depression. Merck Sharp and Dohme, West Point, PA, pp 139–161
Feighner JP (1986) The new generation of antidepressants. In: Rush AJ, Altschuler KZ (eds) Depression: basic mechanisms, diagnosis, and treatment. Guildford Press, New York, pp 205–225
Guy W (ed) (1976) ECDEU Assessment manual for psychopharmacology (revised). National Institute of Mental Health, Psychopharmacology Research Branch, Rockville, MD
Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 12:56–62
Lenox RH, Shipley JE, Peyser JM, Williams JM, Weaver LA (1984) Double-blind comparison of alprazolam versus imipramine in the inpatient treatment of major depressive illness. Psychopharmacol Bull 20 (1):79–82
Montgomery A, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389
Moret C, Charveron M, Finberg JPM, Couzinier JP, Briley M (1985) Biochemical profile of midalcipran (F 2207), l-phenyl-1-diethyl-aminocarbonyl-2-aminomethyl-cyclopropane (Z) hydrochloride, a potential fourth generation antidepressant drug. Neuropharmacology 24:1211–1219
Raskin A, Schulterbrandt J, Reatig N, Rice CE (1967) Factors of psychopathology in interview, word behavior and self-report ratings of hospitalized depressions. J Consult Psychol 31:270–278
Rush AJ, Erman MK, Schlesser MA, Roffwarg HP (1985) Alprazolam vs amitriptyline in depression with reduced REM latencies. Arch Gen Psychiatry 42:1154–1159
Serre C, Clerc G, Escande M, Feline A, Ginestet D, Tignol J, Van Amerongen P (1986) An early clinical trial of midalcipran, a potential fourth generation antidepressant. Curr Ther Res 39:156–164
Spitzer RL, Endicott J, Robins E (1978) Research Diagnostic Criteria: rationale and reliability. Arch Gen Psychiatry 34:773–778
Stenger A, Couziner JP, Briley M (1987) Psychopharmacology of midalcipran, l-phenyl-1-diethyl-amino-carbonyl-2-aminomethylcyclopropane hydrochloride (F 2207), a new potential antidepressant. Psychopharmacology 91:147–153
Van Praag HM (1984) Studies in the mechanism of action of serotonin precursors in depression. Psychopharmacol Bull 20:599–602
Warner MD, Peabody CA, Whiteford HA, Hollister LE (1988) Alprazolam as an antidepressant. J Clin Psychiatry 49:148–150
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ansseau, M., von Frenckell, R., Mertens, C. et al. Controlled comparison of two doses of milnacipran (F 2207) and amitriptyline in major depressive inpatients. Psychopharmacology 98, 163–168 (1989). https://doi.org/10.1007/BF00444686
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00444686