Effect of milnacipran on suicidality in patients with mild to moderate depressive disorder

Original Research

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Authors: Alla Avedisova, Vladimir Borodin, Ksenia Zakharova, et al

Published Date July 2009 Volume 2009:5 Pages 415 - 420

DOI: http://dx.doi.org/10.2147/NDT.S5467

Alla Avedisova, Vladimir Borodin, Ksenia Zakharova, Artem Aldushin

Department of Borderline Psychiatry, FGU State Scientific Research Center of Social and Forensic Psychiatry “V.P. Serbsky”, Moscow, Russia

Abstract: The presence of suicidal manifestations (thoughts and behavior) was studied in a cohort of 30 patients with mild to moderate depression during a 6-week treatment with the serotonin-norepinephrine reuptake inhibitor, milnacipran. At baseline mild suicidal thoughts were present in 46.7% of patients, the mean Hamilton Depression Rating Score (HDRS₁₇) was 23.9 ± 1.8 and the mean suicidality score on the Beck Scale for Suicidal Ideation (BSS) was 4.9 ± 4.9. Suicidal thoughts decreased progressively throughout the study in parallel with other depressive symptoms. At no time during treatment was there any indication of an increased suicidal risk. Notably, the items retardation and psychic anxiety on the HDRS₁₇ decreased in parallel. This may possibly explain the lack of any “activation syndrome”, which is occasionally observed at the early stages of therapy with some antidepressants and may be linked to a temporary increase in suicidal ideation. To our knowledge this is the first detailed report of suicidality during treatment with milnacipran.

Keywords: suicidality, milnacipran, depression

General overview: About 60% of suicides are associated with mood disorders. Although antidepressants are expected to reduce suicidal behavior, certain studies have suggested that some antidepressants may enhance or even induce suicidal ideation. These results are, however, controversial. In addition suicide rates have been shown to decrease since the introduction of modern antidepressants, suggesting that they tend to prevent suicide. In view of this controversy, the presence of suicidal manifestations (thoughts and behavior) was studied in patients with mild to moderate depression during treatment with the serotonin-norepinephrine reuptake inhibitor antidepressant milnacipran, which has been recently introduced into Russia. At baseline, suicidal thoughts were present in 46.7% of patients. During treatment suicidal thoughts decreased progressively in parallel with other depressive symptoms. At no time was there any indication of an increased suicidal risk. This is the first detailed report of suicidality during treatment with milnacipran.