Therapeutic effects of milnacipran, a serotonin and noradrenaline reuptake inhibitor, on post-stroke depression
Kimura M, Kanetani K, Imai R, Suzuki H, Isayama K, Endo S.
Department of Neuropsychiatry,
Nippon Medical School, Tokyo; bMatsue Hospital,
Tokyo; cImai Hospital, Akita, Japan.
Int Clin Psychopharmacol 2002 May;17(3):121-5


Depression is common after stroke. While several reports have been published on the use of antidepressants such as selective serotonin reuptake inhibitors and tricyclics for the treatment of post-stroke depression (PSD), no previous study has examined the use of a selective serotonin and noradrenaline reuptake inhibitor (SNRI) for this condition. The present study investigated the efficacy and safety of milnacipran, a SNRI, for the treatment of PSD. A 6-week open study was conducted in 12 patients (two males and 10 females) aged 53-88 years. All patients were diagnosed with major or minor depressive disorder according to DSM-IV, where onset was subsequent to a cerebral infarction or haemorrhage (stroke). Severity of depression was assessed using the 21-item Hamilton rating scale for depression (HAM-D). The maximum total daily dose of milnacipran was in the range of 30-75 mg b.i.d. Three patients experienced side-effects, but none of the side-effects were serious. Two patients dropped out of the study. At the end of the study, 58.3% (7/12) of the total patient population and 70% (7/10) of the patients completing the study were in remission (a final HAM-D score of less than 7 and no longer meeting criteria for major or minor depression). These results suggest that milnacipran may be an effective treatment for PSD.
Milnacipran: structure
Milnacipran v imipramine
Milnacipran and cognition
Antidepressant metabolism
Antidepressant mechanisms
Milnacipran and the dopamine system
Milnacipran for depression after brain injury

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