Therapeutic effects of milnacipran (serotonin noradrenalin reuptake inhibitor) on depression following mild and moderate traumatic brain injury.
BACKGROUND
The present study investigated the efficacy and safety of milnacipran, a serotonin noradrenalin reuptake inhibitor (SNRI), for the treatment of depression following mild and moderate traumatic brain injury (MMTBI). While other reports have been published on the use of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclics for the treatment of depression following MMTBI, no previous study has examined the use of a SNRI for this condition.


METHODS
A six-week open study was conducted using 10 patients (4 males and 6 females) of ages ranging from 28 to 74 years. DSM-IV (diagnostic statistical manual of mental disorders, 4th Ed. American psychiatric association, 1994) was used to diagnose mood disorders. The severity of depression was measured with the 21-item Hamilton rating scale for depression (HAM-D). The cognitive state of the patients was assessed using the mini-mental state examination (MMSE).


RESULTS
The maximum daily milnacipran dosage for the patients ranged from 30 to 150 mg. One patient experienced side effects, but none of the side effects were serious. On the basis of having a decrease in a final HAM-D score of more than 50%, the response rate for the nine patients was 66.7%, while in a final score of 7 or less, the remission rate for the nine patients was 44.4%. Furthermore, significantly greater improvement in cognitive function was seen in patients treated with milnacipran.


CONCLUSIONS
The results demonstrated that milnacipran is a safe and effective drug for depression following mild and moderate TBI and could be the first choice drug for the treatment of this condition.
Kanetani
Kouichi
K
Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan. kanetani@k6.dion.ne.jp
Kimura
Mahito
M
Endo
Shunkichi
S
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D003521:Cyclopropanes / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D003521:Cyclopropanes; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors