Milnacipran: uses and side effects of this drug

There are plenty of antidepressants on the market, having been synthesizing different substances in order to reduce or eliminate the typical symptoms of depressive episodes.

The different types interact at different levels and in different ways with one or more neurotransmitters, achieving more or less powerful effects and being more or less effective in certain cases. Among the great variety of these drugs that exist, in this article We are going to talk about milnacipran, a very useful SNRI antidepressant.

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What is milnacipran?

Milnacipran is a psychoactive drug made with the purpose of combating depressive symptoms, being a drug that is part of the group of antidepressants. Within them, it is classified as a specific serotonin and norepinephrine reuptake inhibitor or SNRI.

This drug is of great help in the treatment of problems such as passivity and lack of motivation and energy shown by many subjects with depression, as well as when fighting symptoms cognitive. It also improves the level of concentration and attention.

Although it is a medicine approved and used in a large part of the world, the truth is that it does not have the same indications in all countries. approved, since the authorities of different regions have considered that there is not enough data on its efficacy in disorders concrete. However, it is taken into account that it generates benefits in the treatment of both depression and other problems, being the main one fibromyalgia.

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Mechanism of action of the drug

Milnacipran is an SNRI, a serotonin and norepinephrine reuptake inhibitor. This means that its main mechanism of action is based on preventing presynaptic neurons from reabsorb part of the neurotransmitters they have secreted (in this case, specifically serotonin and norepinephrine), so that said neurotransmitter remains available for longer in the synaptic space. Thus, it causes higher concentrations at the brain level of norepinephrine and serotonin.

One aspect to highlight of milnacipran is that it presents a greater action at the noradrenergic level than serotonergic (in a ratio that some studies indicate is 3:1), something infrequent in most antidepressants. It shares this characteristic with another psychoactive drug, which in fact has arisen from milnacipran and is its enantiomer (same chemical components, but rotated): levomilnacipran.

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Disorders in which it is used

Milnacipran is a psychoactive drug whose properties make it useful in different disorders and pathologies. The properties of this drug make it appropriate for the treatment of major depression, in which it presents an efficacy similar to that of venlafaxine (another IRSN) or that of the SSRIs. It is especially useful in the treatment of subjects who present passivity and with little mobility and energy, being used in moderate and severe depressions. It has also been applied to anxious depressions and disorders such as generalized anxiety disorder.

Likewise, various studies have shown that milnacipran is also very useful in the treatment of medical problems that cause chronic pain, such as fibromyalgia. In this last disorder, it contributes to producing an improvement both at the level of reducing pain and that of the cognitive symptoms that usually accompany fibromyalgia. It also seems to improve the mobility of the subjects who suffer from it.

Depending on the place

Curiously, although we are dealing with a substance with antidepressant effects, its application in the treatment of major depressive disorder is not approved in the United States. In that country, milnacipran is approved only for the treatment of fibromyalgia. On the other hand, in much of Europe (including Spain) milnacipran does not have a specific indication for fibromyalgia, but it does in depression.

Despite these differences, the truth is that those affected by both types of condition (which can also occur joint) have presented an improvement in the symptoms, being applied in clinical practice in both one and the other.

Side effects and risks

As with most drugs and psychoactive drugs, the use of milnacipran can be very useful for a large number of people, but sometimes can cause side effects unpleasant and even pose a risk to some people

Some of the most common side effects are hyperhidrosis or excessive sweating, nausea and vomiting, dizziness and flushing, blurred vision, constipation, urinary difficulties or decreased libido. Other more serious side effects are the possibility of tachycardia and hypertension, decreased levels of partner and liver problems. It has also been seen that in some severe cases it can cause seizures.

It has also been seen that in some people with bipolar disorder, it can lead to a manic episode, as well as exacerbate hallucinations and delusions in patients with psychotic disorders. Although some studies seem to indicate that it is not frequent, it can also facilitate the appearance of suicidal thoughts.

Regarding contraindications, pregnant or lactating women should not take milnacipran, as well as in minors. It is contraindicated in people with heart problems (especially those who have recently suffered a heart attack) and kidney problems, as well as narrow-angle glaucoma or urinary problems. Finally, it is contraindicated if the subject follows a treatment with MAOI antidepressants, since their combination could generate a serotonin syndrome.

Bibliographic references:

• Cording, M.; Derry, S.; Phillips, T.; Moore, R. & Wiffen, P.J. (2015). Milnacipran for fibromyalgia in adults. Cochrane Database of Systematic Reviews, 10. Art. No.: CD008244. DOI: 10.1002/14651858.CD008244.pub3.
• Montgomery, S. & Briley, M. (2010). Milnacipran: recent findings in depression. Neuropsychiatric Disease and Treatment, 6 (Suppl. 1): 1-2.