title: A review of antidepressant-induced urinary hesitancy: a focus on levomilnacipran ER including two case presentations(5633).
abstract: BACKGROUND
  Levomilnacipran ER was recently FDA approved as Fetzima® for the treatment of MDD. Urinary hesitancy can be an adverse event associated with levomilnacipran treatment.
  
  
  METHODS
  This manuscript details the longitudinal course of levomilnacipran-induced urinary hesitancy in 2 cases that were in a pivotal clinical trial, examining possible predisposing factors and treatment issues. This manuscript also reviews the literature comparing urinary hesitancy associated with levomilnacipran versus other antidepressants. Antidepressants that are potent norepinephrine reuptake inhibitors like levomilnacipran, may have increased rates of associated urinary hesitancy. The latter can cause significant discomfort and a compromised quality of life. Occasionally, it can progress to urinary retention necessitating an emergency medical intervention.
  
  
  CONCLUSIONS
  All patients being treated with antidepressants should be carefully monitored for this side effect. Discontinuation of treatment or reduction of the dose of antidepressant frequently relieves urinary hesitancy; alternatively, treatment with an alpha1A antagonist, e.g., tamsulosin may relieve antidepressant-induced urinary hesitancy within hours to days; such strategies allow for continued antidepressant treatment without urinary hesitancy recurring. Thus, with appropriate clinical care, the benefits using levomilnacipran outweigh its risks.
authors.affiliation: a Department of Psychiatry and Behavioral Sciences , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Asnis
authors.affiliation: b WESTMED Medical Group , Yonkers , NY , USA.
authors.forename: Elishka
authors.initials: E
authors.lastname: Caneva
authors.affiliation: a Department of Psychiatry and Behavioral Sciences , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Henderson
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003521:Cyclopropanes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D003865:Major Depressive Disorder / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D000078764:Milnacipran; D011788:Quality of Life; D014555:Urination Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology
chemical_list: D000928:Antidepressive Agents; D003521:Cyclopropanes; D003692:Delayed-Action Preparations; D000078764:Milnacipran
keywords: Levomilnacipran ER; acetylcholine; norepinephrine; serotonin; tamsulosin; urinary hesitancy