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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by maree on May 13, 2008, at 22:57:11
I have read posts dated up until about 2004, regarding milnacipran, but not much after.
I have severe reactionary depression, but I also have fibromyalgia, so I am really looking for treatment of the fibro symptoms, WITHOUT the accompanying weight gain, which I am prone to with virtually every AD I have taken.
Has anyone with FM used this medication, what were your results?
My doctor told me that it is not the same as IXEL, anyone comment on this?
Posted by Phillipa on May 13, 2008, at 23:16:58
In reply to mnilnacipran now (2007), posted by maree on May 13, 2008, at 22:57:11
Atmlady comments on Ixel right above your thread about to google it. Phillipa
Posted by Phillipa on May 13, 2008, at 23:25:40
In reply to Re: mnilnacipran now (2007) » maree, posted by Phillipa on May 13, 2008, at 23:16:58
Here's what I found on google. Phillipa
Milnacipran, a new serotonin and noradrenaline reuptake inhibitor: an overview of its antidepressant activity and clinical tolerability
by
Puech A, Montgomery SA,
Prost JF, Solles A, Briley M
Groupe Hospitalier Pitie-Salpetriere,
Paris, France.
Int Clin Psychopharmacol 1997 Mar; 12(2):99-108ABSTRACT
Milnacipran (Ixel) is a new antidepressant with essentially equal potency for inhibiting the reuptake of both serotonin and noradrenaline, with no affinity for any neurotransmitter receptor studied. A review of the studies comparing milnacipran, placebo and active comparator antidepressants provides clear-cut evidence of its efficacy in both severe and moderate depression in hospitalized and community settings. Meta-analyses of the original data of controlled trials involving 1032 patients, comparing milnacipran with imipramine or selective serotonin reuptake inhibitors (SSRIs), show that milnacipran provides antidepressant efficacy similar to that of imipramine and significantly superior to that of the SSRIs. An analysis of a database of over 3300 patients shows that both the general and cardiovascular tolerability of milnacipran are superior to those of the tricyclic antidepressants (TCAs) with fewer cholinergic side-effects. The tolerability of milnacipran was comparable to that of the SSRIs, with a higher incidence of dysuria with milnacipran, and a higher frequency of nausea and anxiety with the SSRIs. Milnacipran is a new therapeutic option in depression, which offers a clinical efficacy in the range of the TCAs combined with a tolerability equivalent to that of the SSRIs.
Posted by bleauberry on May 14, 2008, at 16:33:50
In reply to mnilnacipran now (2007), posted by maree on May 13, 2008, at 22:57:11
I'm not sure what your doctor meant, because IXEL and Milnacipran are one in the same. Different names for the same drug.
Weight gain is very uncommon with it according to literature. In FM clinical trials it had about the same effectiveness of just about anything...50%-60% response rates, some complete remissions, and some failures.
I've read a lot about it at various forums and blogs from users in those clinical trials. Probably the more frequent side effect that caused people to stay at a lower dose than they wanted or to have to stop was increased blood pressure. Despite the literature that claims it is without side effects, some people have lots of side effects and some have none. In that regard, the term "mileage varies" applies and I think the literature is a little bit skewed on the optimistic side.
My experience with Ixel/Milnacipran. Well, first understand that just about any psych drug, even ones that used to be ok with me, make me feel a lot worse really fast. Ever since failed ECT I have been very sensitive and almost 100% prone to paradoxical reactions. When I tried Milnacipran I was of course hesitant and scared of yet another visit to the drug-induced dark place. Imagine my surprise when within one week I was not getting worse, but instead feeling a lot better. Cooking, shopping, housework, day job, socializing, watching TV, thumbing through magazines...all of these things started to improve and I couldn't believe it. I actually had some interest in life.
I was not on it long enough to say anything about pain relief. What it did do...fast antidepressant response even at a low dose; cut the loudness of my tinnitus in half; really good sleep after two nights of worsened sleep at the start; excellent anti-anxiety after two days of feeling revved up at the start; total elimination of this weird racing paranoia scaredness nervousness that I have woken up to every morning for a few years; and more interest in everyday life.
I had to stop because of one of its less frequent side effects...urinary hesitancy. I constricted my bladder/prostate so bad I could barely pee it was dangerous and mighty uncomfortable. The manufacturer's info says that side effect can be countered with Flomax, so I am thinking about that.
Some of the clinical study people said that the FM benefits took as long as 8 months to become fully evident. They said most people quit the drug long before its true benefits came to be.
Posted by SLS on May 15, 2008, at 5:45:03
In reply to Re: mnilnacipran now (2007), posted by bleauberry on May 14, 2008, at 16:33:50
> I had to stop because of one of its less frequent side effects...urinary hesitancy. I constricted my bladder/prostate so bad I could barely pee it was dangerous and mighty uncomfortable. The manufacturer's info says that side effect can be countered with Flomax, so I am thinking about that.
How do you know the urinary hesitancy is due to increased organ size rather than an autonomic side effect? For something autonomic, you might want to try bethanechol (Urecholine). It is a parasympathomimetic ACh muscarinic agonist.
- Scott
Posted by bleauberry on May 15, 2008, at 17:20:26
In reply to Re: mnilnacipran now (2007) » bleauberry, posted by SLS on May 15, 2008, at 5:45:03
Hi Scott,
I don't think the urinary stoppage is due to organ enlargement. It happens too fast (24 hours) for that to be the case. I believe the urinary hesitancy/stoppage/urgency is caused by NE constricting muscles down there. Flomax works by blocking NE effects on the peripheral alpha-1 receptors in bladder, prostate, and peripheral body. I'm not sure if it works in the CNS or not. Others have mentioned behanacol in the past. One person here a few months back was on desipramine with urinary probs like me and said 2mg flomax completely fixed it. Since I already have flomax, but never tried it, that would be the place to start, with bethanacol as an alternative option if flomax has bad effects.
> > I had to stop because of one of its less frequent side effects...urinary hesitancy. I constricted my bladder/prostate so bad I could barely pee it was dangerous and mighty uncomfortable. The manufacturer's info says that side effect can be countered with Flomax, so I am thinking about that.
>
> How do you know the urinary hesitancy is due to increased organ size rather than an autonomic side effect? For something autonomic, you might want to try bethanechol (Urecholine). It is a parasympathomimetic ACh muscarinic agonist.
>
>
> - Scott
Posted by maree on July 25, 2008, at 2:55:45
In reply to Re: mnilnacipran now (2007), posted by Phillipa on May 13, 2008, at 23:25:40
Thanks Philipa, yeah I have Googled it too. For the answer to my questions, a lot of the information comes directly from the pharmaceutical company that is selling it, so, I am afraid I would have to take anything they said with a VERY large grain of salt. I am afraid that I would trust the reply of anybody on PB rather than the manufacturer, since the latter has too much to gain from giving a glowing, rather than a negative report. Apart from which, they are unlikely to report negative side effects, if they only affect less that 5% of users, and, unfortunately, I seem to always get any sort of undesirable side effect. like weight gain, muscular atrophy, IBS, because I am naturally prone to them due to the Fibro already in my body.
This is the end of the thread.
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