A meta-analysis of clinical trials comparing milnacipran, a serotonin-norepinephrine reuptake inhibitor, with a selective serotonin reuptake inhibitor for the treatment of major depressive disorder.
CONTEXT: Over the past few years, a number of studies have emerged suggesting that the treatment of major depressive disorder ( MDD) with antidepressants which enhance both noradrenergic as well as serotonergic neurotransmission may result in higher response or remission rates than treatment with antidepressants which selectively enhance serotonergic neurotransmission. OBJECTIVE: The objective of this paper was to compare response rates among patients with MDD treated with either milnacipran, an antidepressant thought to simultaneously enhance both noradrenergic and serotonergic neurotransmission, or a selective serotonin reuptake inhibitor (SSRI). DATA SOURCES: Medline/Pubmed were searched. No year of publication or language limits were used. STUDY SELECTION: Double-blind, randomized clinical trials comparing milnacipran with an SSRI for the treatment of MDD. DATA EXTRACTION: Data were extracted with the use of a pre-coded form. DATA SYNTHESIS: Analyses were performed comparing response rates between the two antidepressant agents. Data from 6 reports involving a total of 1082 outpatients with MDD were identified and combined using a random-effects model. Patients randomized to treatment with milnacipran were as likely to experience clinical response as patients randomized to treatment with an SSRI according to the MADRS (RR=1.04, 95% CI: 0.88-1.23, p=0.533) or the HDRS (RR=1.06, 95% CI: 0.90-1.24, p=0.456) for the random effects model. Simply pooling MADRS-based response rates between the two agents revealed a 58.9% response rate for milnacipran and a 58.3% response rate for the SSRIs. Similarly, HDRS-based response rates were 59.7% and 57.5%. There was also no difference in overall discontinuation rates (RR=0.93; 95% CI: 0.76-1.14; p=0.506), the rate of discontinuation due to adverse events (RR=0.77; 95% CI: 0.55-1.1; p=0.157), or the rate of discontinuation due to inefficacy (RR=0.98; 95% CI: 0.7-1.38; p=0.95) between the two groups. CONCLUSIONS: These results suggest that milnacipran and the SSRIs do not differ with respect to their overall efficacy in the treatment of MDD.[1]References
- A meta-analysis of clinical trials comparing milnacipran, a serotonin-norepinephrine reuptake inhibitor, with a selective serotonin reuptake inhibitor for the treatment of major depressive disorder. Papakostas, G.I., Fava, M. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology (2007) [Pubmed]
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