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

@article{Papakostas2007AMO,
  title={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},
  author={George I. Papakostas and Maurizio Fava},
  journal={European Neuropsychopharmacology},
  year={2007},
  volume={17},
  pages={32-36}
}
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… 
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Serotonergic-noradrenergic antidepressant drugs seem to have a modest efficacy advantage compared with SSRIs in MDD, and further research is needed to examine whether larger differences between classes of antidepressant drugs might exist in specific MDD sub-populations or for specificMDD symptoms.
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The results suggest that the NRI reboxetine and the SSRIs differ with respect to their side-effect profile and overall tolerability but not their efficacy in treating MDD.
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TLDR
Until it is possible to select patients who are more likely to respond to specific classes of drugs based on certain genes or biomarkers, data suggest that dual-acting antidepressants are slightly more effective than those that are selective for a single neurotransmitter in the treatment of patients with MDD.
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TLDR
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TLDR
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.
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ANTIDEPRESSANT EFFICACY OF SELECTIVELY INCREASING BRAIN SEROTONIN AND / OR NOREPINEPHRINE
Major depressive disorder (MDD) is a complex condition resulting from numerous genetic and physiologic factors. This article reviews the neurochemical mechanisms underlying MDD, summarizes recent
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TLDR
It will be not surprising to predict the potential success of ALKS 5461 (a combination of buprenorphine and ALKS-33) in the near future and CERC-501 will be expected to be available as monotherapy or adjuvant therapy with other first-line antidepressants in the treatment of TRD, if ongoing clinical trials continue to provide positive benefit-risk profiles.
Milnacipran: a unique antidepressant?
TLDR
Clinical studies have shown that milnacipran has efficacy comparable with the TCAs and is superior to SSRIs in severe depression, and it is frequently successful when other treatments fail for reasons of efficacy or tolerability.
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