Milnacipran versus other antidepressive agents for depression
Editorial Group: Cochrane Depression, Anxiety and Neurosis Group
Published Online: 8 JUL 2009
Assessed as up-to-date: 31 JUL 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Nakagawa A, Watanabe N, Omori IM, Barbui C, Cipriani A, McGuire H, Churchill R, Furukawa TA. Milnacipran versus other antidepressive agents for depression. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006529. DOI: 10.1002/14651858.CD006529.pub2.
- Publication Status: New
- Published Online: 8 JUL 2009
Although pharmacological and psychological interventions are both effective for major depression, antidepressant drugs are frequently used as first-line treatment in primary and secondary care settings. Milnacipran, a dual serotonin-norepinephrine reuptake inhibitor (SNRI), is one of the antidepressant drugs that clinicians use for routine depression care.
To assess the evidence for the efficacy, acceptability and tolerability of milnacipran in comparison with tricyclic antidepressants (TCAs), heterocyclics, SSRIs and other newer antidepressive agents in the acute-phase treatment of major depression.
The Cochrane Collaboration Depression, Anxiety & Neurosis review group Controlled Trials Register (CCDANCTR-Studies and CCDANCTR-References) were electronically searched in August 2008. References of relevant trials and other reviews were also checked. Trial databases of the drug-approving agencies and ongoing clinical trial registers for all published and unpublished trials were hand-searched in 2007. All relevant authors were contacted for supplemental data. No language restriction was applied.
Randomised controlled trials comparing milnacipran with any other active antidepressive agents (including non-conventional agents such as herbal products like hypericum) as monotherapy in the acute phase of major depression were selected.
Data collection and analysis
Two reviewers independently checked eligibility, assessed methodological quality and extracted data from the eligible trials using a standardised data extraction form. The number of participants who responded to treatment or those who achieved remission were calculated on an intention-to-treat basis. Random-effects meta-analyses were conducted, combining data from the included trials.
A total of 16 randomised controlled trials (n=2277) were included in the meta-analysis.Despite the size of this sample, the pooled 95% confidence intervals were rather wide and there were no statistically significant differences in efficacy, acceptability and tolerability when comparing milnacipran with other antidepressive agents. However, compared with TCAs, patients taking milnacipran were associated with fewer dropouts due to adverse events (OR 0.55; 95%CI 0.35 to 0.85). There was also some weak evidence to suggest that patients taking milnacipran experienced fewer adverse events of sleepiness/ drowsiness, dry mouth or constipation compared with TCAs.
Currently, there is inadequate evidence to conclude whether milnacipran is superior, inferior or the same as other antidepressive agents in terms of efficacy, acceptability and tolerability in the acute phase treatment of major depression. However, there is some evidence in favour of milnacipran over TCAs in terms of dropouts due to adverse events (acceptability) and the rates of experiencing adverse events (tolerability). Information about other clinically meaningful outcomes such as cost-effectiveness and social functioning, including the ability to return to work, is lacking. Further study is needed to answer whether milnacipran would be the better choice of antidepressant for acute major depression.
Plain language summary
Milnacipran versus other antidepressive agents for depression
Major depression, also known as major depressive disorder or unipolar depression, is a common mental disorder characterised by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy pleasurable activities. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
Antidepressant drugs are frequently used as first-line treatment for major depression in primary and secondary care settings. Milnacipran, a dual serotonin-norepinephrine reuptake inhibitor, is one of the antidepressant drugs that clinicians use for routine depression care.This systematic review investigated the efficacy, acceptability and tolerability of milnacipran compared to that of other antidepressive agents in the acute phase treatment of major depression. A total of 16 randomised controlled trials (2277 participants) were included in this review. When we brought together the results of approximately 2000 patients, we were unable to say whether milnacipran is better, worse or the same when compared to other antidepressive agents used in practice in terms of efficacy, acceptability and tolerability. However, there is some evidence that fewer people taking milnacipran stop taking the drug ('drop out') due to side effects and fewer people taking milnacipran experience side effects such as sleepiness, dry mouth or constipation than do people who take tricyclic antidepressants.
2008年八月電子搜尋Cochrane Collaboration Depression, Anxiety & Neurosis review group Controlled Trials Register (CCDANCTRStudies and CCDANCTRReferences).也檢查相關試驗的文獻和其他回顧.2007年手動搜尋核准藥品上市機關的資料庫中發表和未發表的試驗.連絡相關作者取得補充資料.沒有語言限制.
共納入16個隨機對照試驗(樣本數為2277)作後設分析.雖然樣本大但95%信賴區間仍頗寬,且milnacipran和其他抗精神病藥物相比較,療效,耐受性和接受度都沒有顯著不同差異.和三環抗憂鬱劑相比, 使用milnacipran的病患較少因副作用退出試驗(OR 0.55; 95%CI 0.35 to 0.85).也有微弱證據顯示和三環抗憂鬱劑相比,使用milnacipran的病患有較少的嗜睡,口乾或便秘副作用
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
重鬱症又稱為重度憂鬱鬱症候群或單極憂鬱症.是常見的精神疾病,其特徵包含許多症狀會影響工作,睡眠,唸書,吃飯和享樂的能力.一個人一生可能只會有一次重鬱症發作,但比較多會復發.抗憂鬱藥物為第一二線機構較常作為第一線的治療. Milnacipran為有血清素及正腎上腺素再回收抑制劑(SNRI),為抗憂鬱藥之一,用於憂鬱症一般治療.本系統性回顧研究milnacipran與其他抗憂鬱藥物相比,在急性期治療重鬱症的療效,耐受性和接受度. 共納入16個隨機對照試驗(樣本數為2277).同時研究這近2000比資料時,卻無法確認與其他抗憂鬱藥物相比,是否milnacipran的療效,耐受性和接受度較好或差.然而有一些證據顯示比較少使用milnacipran的病患因副作用停止用藥(退出試驗),他們也比使用三環抗憂鬱劑的病患少發生嗜睡,口乾或便秘副作用