Milnacipran: uses and side effects of this drug

Although this drug is an antidepressant, it is also used against fibromyalgia.

There are a large number of antidepressants on the market, and different substances have been synthesized 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 several neurotransmitters, achieving more or less potent effects and being more or less effective in certain cases. From among the great variety of these drugs that exist, in this article we are going to talk about milnacipran, a very useful SNRI antidepressant..

What is milnacipran?

Milnacipran is a psychopharmaceutical designed to combat depressive symptoms, being a drug that is part of the group of antidepressants. Among them, it is classified as a specific serotonin and norepinephrine reuptake inhibitor or SNRI. 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 in combating cognitive symptomatology. It also helps to improve the level of concentration and attention.

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

Mechanism of action of the drug

Milnacipran is an SNRI, a serotonin and noradrenaline reuptake inhibitor. This means that its main mechanism of action is based on preventing presynaptic neurons from reabsorbing part of the neurotransmitters. part of the neurotransmitters they have secreted (in this case, specifically serotonin and (in this case, specifically serotonin and noradrenaline), so that this neurotransmitter remains more time available in the synaptic space. Thus, there are higher concentrations of noradrenaline and serotonin in the brain.

A noteworthy aspect of milnacipran is that it has a greater noradrenergic than serotoninergic action (in a ratio that some studies indicate is 3:1), which is uncommon in most antidepressants. This characteristic is shared with another psychotropic drug, which in fact has emerged from milnacipran and is its enantiomer (same chemical components, but rotated): levomilnacipran.

Disorders in which it is used

Milnacipran is a psychotropic 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 SNRI) or SSRIs. It is especially useful in the treatment of subjects with passivity and low mobility and energy, being used in moderate depressions.It is used in moderate and severe depressions. It has also been applied to anxious depressions and disorders such as generalized anxiety disorder.

In addition, several studies have shown that milnacipran is also very useful in the treatment of medical problems involving chronic pain, such as fibromyalgia. In the latter disorder, it contributes to produce an improvement both in terms of reducing pain and cognitive symptoms that usually accompany fibromyalgia. It also appears to improve the mobility of sufferers.

Depending on the location

Curiously, although we are dealing with a substance with Antidepressant effects, in the United States it is not approved for use in the treatment of major depressive disorder.. In that country, milnacipran is only approved for the treatment of fibromyalgia. On the other hand, in most of Europe (including Spain) milnacipran has no specific indication for fibromyalgia, but it is approved for depression.

In spite of these differences, the fact is that those affected by both types of condition (which can also occur together) have shown an improvement in symptomatology, being applied in clinical practice both in one and the other.

Side effects and risks

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

Some of the most common side effects are hyperhidrosis, or excessive sweating excessive sweating, nausea and vomiting, dizziness and hot flushes, blurred vision, constipation, urinary difficulties or decreased urinary function.urinary difficulties or decreased libido. Other more serious side effects are the possibility of tachycardia and hypertension, decreased blood sugar levels 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, milnacipran should not be taken by pregnant women or nursing mothersIt should not be taken by pregnant or lactating women, nor by minors. It is contraindicated in people with heart problems (especially those who have recently suffered a heart attack) and kidney problems, as well as in narrow-angle glaucoma or urinary problems. Finally, it is contraindicated if the subject is following a treatment with MAOI antidepressants, since their combination could generate a serotoninergic 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 (Supl. 1): 1-2.