Tag Archives: Milnacipran

Minor Depression

Etiology and Pathophysiology Minor depression is only a proposed diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and there are no International Classification of Diseases codes to categorize it. The proposed diagnostic category for minor depression in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition describes a depressive disorder that… Read More »

Minor Depression: Duloxetine, Venlafaxine, and Milnacipran

Serotonin-Norepinephrine Reuptake Inhibitors Several antidepressants have dual action at both serotonergic and noradrenergic receptors. The most notable are the serotonin/norepinephrine reuptake inhibitors, particularly extended-release venlafaxine (Wyeth’s Effexor XR) and milnacipran (bioMerieux-Pierre Fabre’s Ixel/Dalcipran, Asahi Kasei/Janssen-Kyowa’s Toledomin; available only in France and Japan). The noradrenergic and specific serotonergic antidepressants (NaSSAs) mirtazapine (Organon’s Remeron/Remergil), nefazodone (Bristol-Myers Squibb’s… Read More »

Minor Depression: Escitalopram, Paroxetine, Sertraline, and Fluoxetine

Selective Serotonin Reuptake Inhibitors The seven available agents in the selective serotonin reuptake inhibitor class are citalopram (Lund-beck’s Cipramil, Forest Laboratories’ Celexa, generics) and its single enan-tiomer, escitalopram (Lundbeck’s Cipralex, Forest’s Lexapro); paroxetine (GSK’s Paxil/Seroxat, Novartis’s Frosinor, generics); the controlled-release version of paroxetine (GSK’s Paxil CR); sertraline (Pfizer’s Zoloft); fluoxetine (Eli Lilly’s Prozac, generics); and… Read More »

Minor Depression: Serotonin-Norepinephrine Reuptake Inhibitors

Research and development efforts in depression are focusing on a wide variety of mechanisms; agents with the now-familiar mechanism of serotonin-norepinephrine reuptake inhibition make up only a small portion of development efforts. The most notable of these serotonin/norepinephrine reuptake inhibitors is Eli Lilly’s recently launched duloxetine. Duloxetine is the third serotonin/norepinephrine reuptake inhibitor to market,… Read More »

Chronic Illness: Current Therapies

The main goal of bipolar disorder drug treatment is to establish euthymia (stable mood with a persistent sense of well-being) without inducing mania or rapid cycling (i.e., four or more mood episodes in a 12-month period). For this reason, drug treatment usually consists of an agent or, more frequently, combinations of agents that exert both… Read More »

Chronic Illness: Emerging Therapies

Few new drugs are in clinical development for the treatment of Bipolar disorder. Most agents in clinical trials for this disorder (e.g., Bristol-Myers Squibb’s aripiprazole, Novartis’s oxcarbazepine, AstraZeneca’s quetiapine, Janssen’s risperidone, Ortho-McNeil’s topiramate, Pfizer’s ziprasidone) are already available in the major markets (United States, France, Germany, Italy, Spain, United Kingdom, and Japan) for the treatment… Read More »

Adverse Effects of Treatment Drugs in Long-Term Use

Long-Term Adverse Effects of Psychostimulants Psychostimulants have been used for many years for the treatment of narcolepsy. Adequate control of somnolence in the daytime is usually possible. However, this control is not always possible because of side effects and nonadherence. The awakening effects of psychostimulants should not be extended beyond evening meals to minimize remaining… Read More »

Practical issues in using antidepressants

Factors influencing antidepressant choice Selective serotonin reuptake inhibitors (SSRIs) and dual-action antidepressants are the predominant first choice treatments for major depressive disorder, although the evidence in favor of superior efficacy compared to classical antidepressants is limited. Their superior safety and tolerability profiles account for their widespread use, yet side-effects are not insubstantial and vary across… Read More »

Tricyclic Antidepressants

The tricyclic antidepressants – TCAs Tricyclic antidepressants continue to be prescribed worldwide (Table Dosing of Tricyclic Antidepressants), although in most countries they are considered second line agents due to their limited safety and tolerability. Among the tertiary amines, amitriptyline, clomipramine and imipramine are the main mixed-uptake blocking agents and have been most extensively investigated. In… Read More »

Second and third generation antidepressants

Selective Serotonin Reuptake Inhibitors Serotonin and norepinephrine reuptake inhibitor (SNRI) and other antidepressants Venlafaxine, milnacipran and duloxetine all inhibit both 5HT and norepinephrine reuptake, albeit in different ratios. Venlafaxine more potently inhibits the 5HT transporter, milnacaprin has more norepinephrine inhibiting effects and duloxetine appears to provide a more balanced dual inhibition. Desvenlafaxine succinate (DVS), an… Read More »