View Full Version : MILNACIPRAN...The latest norepinephrine serotonin reuptake inhibitor.

03-05-05, 04:15 PM
Milnacipran, (also known as Midalcipran) is the first in a new class of antidepressants known as Norepinephrine Serotonin Reuptake Inhibitors (or NSRI's).

What makes Milnacipran different from the SSRI drugs like ProzacŪ and SNRI antidepressant types like Effexor, is that Milnacipran affects two neurotransmitters - norepinephrine and serotonin - almost equally (a 3:1 norepinephrine to serotonin balance). In contrast an SNRI, tends to act much more on serotonin than norepinephrine, (Effexor has a 1:30 norepinephrine to serotonin ratio).

It is this essentially "equal" potency that makes Milnacipran a promising treatment for chronic pain conditions like Fibromyalgia and Lupus. To learn more about this please read the article by clicking here.

It is believed that the combination of Milnacipran's norepinephrine and serotonin enhancement action has an analgesic, (pain-killing) effects. The second generation, Tricyclic antidepressants (TCA's), like Amitriptyline (which has a 1.6:1 norepinephrine to serotonin balance), have a proven record in treating chronic pain. Unfortunately, the TCA medications are also known for having more negative side-effects than the SSRI and SNRI antidepressants which have followed them. It is hoped that the newer antidepressants like Milnacipran will be able to affect multiple pain mechanisms in a manner similar to that seen with some tricyclic antidepressants, but without the negative side effects of the TCA's.

Milnacipran not only inhibits the reuptake of Serotonin, it also has an action to inhibit the uptake of Noradrenaline. Both these factors have been shown to be efficacious in the treatment of depression.

However, most SSRIs have some particular side effects that are not welcome. The most common being an increase in the prevalence of erectile dysfunction, or a decrease in libido (sex drive). These effects have not been noted with Milnacipran, which is why it has been receiving a lot of attention as a "new kind" of anti-depressant. In fact, Milnacipran appears to be as effective as the tri-cyclic anti-depressants whilst having fewer side effects than most SSRIs.

Dosages for depression are usually in the order of 25mg to 50mg daily, (maximum 100mg). Like most anti-depressants there are contraindications with other anti-depressants and MAO inhibiting drugs, these would include Gerovital-H3, Deprenyl and Manerix etc., therefore combined use is not advised, (unless under the guidance of a physician). Furthermore, we would not advise combination with other Serotonin or Noradrenaline enhancing agents such as Adrafinil, Modafinil, Paxil, ProzacŪ, Yohimbine and Zoloft etc., (unless you are under the guidance of a physician).

03-05-05, 08:30 PM
oooh, how timely!

I live in Japan and was just prescribed this yesterday, along with a benzo called Lexotan (Toledomine). For some reason the doc (who may or may not have a beak and webbed feet) said I could stay on my current 400mg/day Provigil, 60mg/day Strattera, 30mg/day Ritalin habit too. Call Tom Cruise--I've got me a cocktail goin'!

I wonder when/if this drug will get FDA-approval...

abre los ojos
03-10-05, 03:28 AM
I've been taking Milnacipran for about 3 weeks. It's a great drug. It has very low side-effects and has low toxicity. You can also take it with just about any other drug, because it has essentially no interactions. This is also a very good drug for ADD because if its effect on Norepeinephine and it effect on increasing Dopamine in the Brains Cortex. Scientific studies in Japan have shown show that when you add a Dopamine drug to it, like ritalin, it produces amazing results in concentration, reduction of pain, depresssion, increased drive and motivation.

Ritalin and Milnacipran is the best combination of pain medications ive ever taken. My chronic TMJ is completely absent.

Milnacipran is so much less toxic and doesnt have any were close to the the side-effects that Cymbalta has. The only reason Cymbalta was approved before Milnacipran is because the FDA is totally corrupt.

abre los ojos
03-10-05, 03:31 AM
<CENTER><BIG>Addition of a dopamine agonist, cabergoline, to a serotonin-noradrenalin reuptake inhibitor, milnacipran as a therapeutic option in the treatment of refractory depression: two case reports</BIG>
Takahashi H, Yoshida K, Higuchi H,
Shimizu T, Inoue T, Koyama T.
Department of Neuro-Psychiatry,
Akita University School of Medicine, Akita,
Omagari City Hospital, Omagari,
Department of Psychiatry,
Hokkaido University Graduate School of Medicine,
Sapporo, Japan.
Clin Neuropharmacol. 2003 Sep-Oct;26(5):230-2</SMALL>



<BIG><BIG>S</BIG></BIG>UMMARY: We illustrate 2 patients with depression who attained dramatic improvement of energy loss and fatigue when treated with cabergoline, a dopamine agonist, and milnacipran, a serotonin-noradrenalin reuptake inhibitor. Although the biologic basis of energy, motivation, and fatigue in association with depression remains unknown, some reports suggest that the decrease of noradrenalin and dopamine in the brain are particularly related to these symptoms. Therefore, treatment strategy that enhances these two monoamine neurotransmissions may be appropriate for getting a boost in energy and eliminating fatigue in patients with depression. These cases suggest that further studies are warranted to confirm the potential benefit of this strategy in the treatment of patients with depression who failed to attain complete remission due to residual symptoms including energy loss and fatigue refractory to previous treatments.

PS. You can use Ritalin or other drugs that increase dopamine

03-10-05, 11:22 AM
abre los ojos, you made my day! thanks for posting this info.

As i mentioned above I also got put on an anti-anxiety tranquilizer drug, and it has me on my ***. I think I will drop that and run with the Milnacipran and Ritalin. Can you tell me how much Ritalin you take and when? I take 25mg Milnacipran and 10mg Ritalin 3x/day, but had to add Ritalin to counter the effects of the tranquilizer...

I'm pretty sure that both Strattera and Provigil increase dopamine, so I can take them too, right? (don't worry, I'm not looking to you for medical advice, just anecdotal, since my doc here doesn't seem to have a clue...)

doumo arigatou! Glad to hear it's working for you.

abre los ojos
03-12-05, 02:05 AM
Hey Kitty,

We are all so individually different, so the best way to find out what medication suits you best is to try them all. It sounds like your Dr. is at least willing to try a lot of different things. Psychopharmachology has a lot of wonderful tools in the tool box, but even the best psychopharmacologist end up using the trial and error method to find the right medication for the right person. We are our best advocate.

03-21-05, 02:20 PM
I am currently on my 5th day of taking Cymbalta and I've gotten more tired by the day. Today I can hardly function and this is not good considering I have three kids to take care of. I finally got up enough energy to make some coffee. Does anyone know how long this tiredness can last? I am very interested to find out about milnacipran. I don't feel that I experience much chronic pain, although I do often have muscle tension. Right now this Cymbalta actually seems to be making that worse. Anyone having good results with the cymbalta?

06-10-05, 04:46 PM
Abre from what you just told me Milnacipran sounds like a good one.

06-14-05, 07:54 PM
Abre from what you just told me Milnacipran sounds like a good one. It's been around for awhile now, but it isn't marketed in the US. Look into Cymbalta... same deal.