Remission rates with milnacipran 100 mg/day and 150 mg/day in the long-term treatment of major depression

Abstract

Background: The aim of this study was to determine remission rates during treatment with two different dosages of milnacipran, and the effect of milnacipran therapy for at least 1 year on the maintenance of remission and tolerability, in outpatients with major depression.

Methods: The study included 41 outpatients with major depression who initially received milnacipran 50 mg/day for 1-2 weeks, followed by a dosage increase to 100 mg/day for 12 weeks. Patients who achieved remission (17-item Hamilton Depression Rating Scale [HDRS] scores <or=7) after 12 weeks of milnacipran 100 mg/day treatment continued at the same dosage and were followed for at least 1 year. For patients who had decreased HDRS scores, but failed to attain remission, the dosage of milnacipran was increased to 150 mg/day, and those who achieved remission were then followed for at least 1 year.

Results: Eight out of 41 patients were withdrawn from the study prematurely because of adverse events (eight events in six patients: nausea, thirst, urinary discomfort, rapid pulse, palpitations, staggering sensation or sweating) or as a result of the patient's decision (two patients). Thirteen (31.7%) of 41 patients achieved remission during treatment with milnacipran 100 mg/day. Of the remaining 20 patients, 17 underwent a dosage increase to 150 mg/day, and 13 achieved remission at a second assessment (cumulative remission rate: 63.4%). No adverse events or recurrence of symptoms were found in any of the patients who achieved remission during the subsequent follow-up period of a minimum of 1 year.

Conclusions: The results of this study showed milnacipran 150 mg/day and 100 mg/day to be effective and well tolerated in the long-term treatment of outpatients with major depression, and indicated that a dosage of 150 mg/day is an effective therapeutic option for depression when a dosage of 100 mg/day does not provide a satisfactory response.