Efficacy and Safety of Milnacipran Vs Duloxetine in Major Depression in Indian Patients

The objective of the study was to compare the efficacy and safety of milnacipran and duloxetine in major depressive disorder. The study was conducted in 120 patients suffering from major depressive disorder as per DSM-IV criteria. Patients were randomized to two groups and were given milnacipran (25, 50mg BD) and duloxetine (20, 30mg BD) for 8 weeks. The primary efficacy parameter was the Hamilton Depression Rating Scale (HDRS-17) and Montgomery and Asberg depression rating scale (MADRS). Secondary efficacy parameters included proportion of patient responds to the treatment, proportion of patient remission to the treatment and changes in the score of clinical global impression (CGI) scale. Safety evaluation was based on treatment emergent adverse effects. There was significant decrease in HDRS, MADRS, CGI scores from baseline to end of treatment (p<0.05) in both the groups. However the difference in scores between two groups was not statistically significant. Total mean HDRS score decreased from 30.54 (SD=5.93) to 11.96 (SD=5.18) in milnacipran group and from 32.78(SD=7.47) to 12.20 (SD=5.71) in duloxetine group at the end of treatment. Total mean MADRS score decreased from 37.56 (SD=6.66) to 15.41 (SD=5.78) in milnacipran group and from 39.78(SD=8.84) to 15.65 (SD=6.63) in duloxetine group at the end of treatment. Responder and remission rate was 72.22% and 31.48% in milnacipran group as compared to 65.45% and 32.72% in duloxetine group respectively. There was no significant difference in adverse effects between two groups. The findings of this study indicate that milnacipran may be an effective and safe antidepressant in Indian patients of major depressive disorder. It is equally effective to duloxetine in patients of depression.

Author(s): Devang S Patel and Shrikalp S Deshpande

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