Milnacipran; Fluvoxamine; Antidepressant; Loading dose; Endogenous depression; Major depression
Abstract :
[en] A multicenter controlled study was designed to test the hypothesis that a loading dose of an antidepressant could shorten the latency of its clinical efficacy. Three parallel groups of about 40 endogenous depressive inpatients received either a loading dose of milnacipran (300 mg daily for 2 weeks and 150 mg daily during the 2 following weeks), the standard regimen of milnacipran in severe depression (200 mg daily for 4 weeks), or fluvoxamine (200 mg daily for 4 weeks). The duration of the study was 4 weeks, with assessments at baseline and after 4, 9, 14, 21, and 28 days of therapy by means of Montgomery and Asberg depression scale (MADS), the Hamilton depression scale, the Clinical Global Impressions (CGI), and a checklist of symptoms and side-effects. Results showed very similar evolution in the 3 treatment groups. In addition, the level of side-effects did not exhibit significant differences among the treatment groups, except for excitement-nervousness and akathisia which were more frequently reported with fluvoxamine. These results do not support the usefulness of a loading dose of an antidepressant such as milnacipran. They demonstrate however that milnacipran can be given at a 300 mg daily dose from the very first day of treatment with an excellent tolerance.
Disciplines :
Treatment & clinical psychology
Author, co-author :
Ansseau, Marc ; Université de Liège - ULiège > Département des sciences cliniques > Psychiatrie et psychologie médicale
von Frenckell, Rémy ; Université de Liège - ULiège > Psychiatrie et psychologie médicale
Gérard, Marie-Anne; Centre Hospitalier Universitaire de Liège - CHU
Mertens, C.
De Wilde, J.
Botte, L.
Devoitille, J. M.
Evrard, J. L.
De Nayer, A.
Orban, Pierre ; Université de Liège - ULiège > Centre de recherches du cyclotron
Language :
English
Title :
Interest of a Loading Dose of Milnacipran in Endogenous Depressive Inpatients. Comparison with the Standard Regimen and with Fluvoxamine
Amin, Ananth, Coleman, Darcourt, Farkas (1984) Fluvoxamine antidepressant effects confirmed in a placebo-controlled international study. Clinical Neuropharmacology 7:S312-S319.
Angst, Bech, Boyer, Bruinvels, Engel, Helmchen, Hippius, Lingjaerde, Racagni, Saletu, Sedvall, Silverstone, Stefanis, Stoll, Woggon (1989) Consensus conference on the methodology of clinical trials of antidepressants. Pharmacopsychiatry , Zurich, March 1988, Report of the Consensus Committee; 22:3-7.
Ansseau, Devoitille, Papart, Vanbrabant, Mantanus, Timsit-Berthier (1991) Comparison of adinazolam amitriptyline and diazepam in endogenous depressive inpatients exhibiting DST nonsuppression or abnormal contingent negative variation. J Clin Psychopharmacol, in press; .
Ansseau, von Frenckell, Mertens, de Wilde, Botte, Devoitille, Evrard, De Nayer, Darimont, Dejaiffe, Mirel, Meurice, Parent, Couzinier, Demarez, Serre (1989) Controlled comparison of two doses of milnacipran (F 2207) and amitriptyline in major depressive inpatients. Psychopharmacol 98:163-168.
Ansseau, von Frenckell, Papart, Mertens, de Wilde, Botte, Devoitille, Evrard, De Nayer, Koch-Bourdouxhe, Darimont, Lecoq, Mirel, Couzinier, Demarez, Serre (1989) Controlled comparison of milnacipran (F2207) 200 mg and amitriptyline in endogenous depressive inpatients. Hum. Psychopharmacol 4:221-227.
Assie, Broadhurst, Briley (1988) Is down-regulation of β-adrenoreceptors necessary for antidepressant activity. New Concepts in Depression , M. Briley, G. Fillion, MacMillan Press, London; 161-166.
Baldessarini (1989) Current status of antidepressants: clinical pharmacology and therapy. J. Clin. Psychiat 50:117.
Bannerjee, Kung, Riggi, Chandra (1977) Development of β-adrenergic receptor subsensitivity by antidepressants. Nature 268:455-456.
Benfield, Ward (1986) Fluvoxamine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness , Drugs; 32:313-334.
Clerc, Pagot, Bouchard, Oules, Guibert, Amicot, Guillard, Cottin, Dachary, Bezoury, Parmentier, Gresle, von Frenckell, Serre (1990) Intérêt thérapeutique du milnacipran et de la clomipramine au cours d'un traitement de 3 mois: résultats d'un essai comparatif. Psychiat. Psychobiol 5:137-146.
Covi, Lipman, McNair, Czerlinski (1979) Symptomatic volunteers in multicenter drug trials. Prog. Neuropsychopharmacol 3:521-533.
Feighner (1986) The new generation of antidepressants. Depression: Basic Mechanisms, Diagnosis, and Treatment , A.J. Rush, K.Z. Altschuler, Guildford Press, New York; 205-225.
Guy ECDEU Assessment Manual for Psychopharmacology, National Institute of Mental Health, Psychopharmacology Research Branch, Rockville, MD, (revised); 1976.
Guy, Bonato Manual for the ECDEU Assessment Battery, 2nd edn., National Institute of Mental Health, Chevy Chase; 1970.
Hamilton (1960) A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry 12:56-62.
Itil, Shrivastava, Mukherjee, Coleman, Michael (1983) A double-blind placebo-controlled study of fluvoxamine and imipramine in out-patients with primary depression. British Journal of Clinical Pharmacology 15:433S-438S.
Macher, Sichel, Serre, von Frenckell, Huck, Demarez (1989) Double-blind placebo-controlled study of milnacipran in hospitalized patients with major depressive disorders. Neuropsychobiology 22:77-82.
Mathieu New drug development: a regulatory overview, Parexel, Cambridge, MA; 1990.
Ministère, la Santéet de la Famille, Direction de la Pharmacie et du Médicament (1987) Bonnes pratiques cliniques. Avis aux promoteurs et aux investigateurs pour les essais cliniques des médicaments, Texte officiel en langue française, Paris, France; .
Montgomery, Asberg (1979) A new depression scale designed to be sensitive to change. Br. J. Psychiat 134:382-389.
Pull (1990) French experiences with the Hamilton scales in comparison with other scales for depression and anxiety. The Hamilton scales , P. Bech, A. Coppen, Springer Verlag, Berlin; 35-39.
Raskin, Schulterbrandt, Reatig, Rice (1967) Factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressions. J. Consult. Psychol 31:270-278.
Rudorfer, Potter (1989) Antidepressants. A comparative review of the clinical pharmacology and therapeutic use of the ‘newer’ versus the ‘older’ drugs , Drugs; 37:713-738.
Schwartz L'essai thérapeutique chez l'homme, Flammarion, Paris; 1970.
Siddiqui, Chakravarti, Jesinger (1985) The tolerance and antidepressive activity of fluvoxamine as a single dose compared to a twice daily dose. Curr. Med. Res. Opin 9:681-690.
Spitzer, Endicott, Robins (1978) Research Diagnostic Criteria rationale and reliability. Archives of General Psychiatry 34:773-778.
Stenger, Couzinier, Briley (1987) Psychopharmacology of midalcipran, 1-phenyl-1-diethyl-amino-carbonyl-2-amino-methylcyclopropane hydrochloride (F2207), a new potential antidepressant. Psychopharmacology 91:147-153.
Sulser (1979) New perspectives on the mode of action of anti-depressant drugs. Trends Pharmacol. Sci 1:92.
von Frenckell, Ansseau, Serre, Sutet (1990) Pooling two controlled comparisons of milnacipran (F2207) and amitriptyline in endogenous inpatients. Int. Clin. Psychopharmacol 5:49-56.
Wakelin (1988) The role of serotonin in depression and suicide: do serotonin reuptake inhibitors provide a key. Adv. Biol. Psychiat 17:70-83.
Wakelin, Coleman (1986) The influence of the 5-HT specific antidepressant, fluvoxamine maleate on suicidal behaviour. Int. J. Neurosci 31:216.