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Japanese experience with milnacipran, the first serotonin and norepinephrine reuptake inhibitor in Japan

Authors Teruhiko Higuchi, Mike Briley

Published 15 March 2007 Volume 2007:3(1) Pages 41—58

Teruhiko Higuchi1, Mike Briley2

1Musashi Hospital, National Centre for Neurology and Psychiatry, Tokyo, Japan; 2NeuroBiz Consulting & Communications, Castres, France

Abstract: Milnacipran is a serotonin and norepinephrine reuptake inhibitor (SNRI), with a balanced potency for the inhibition of the reuptake of the two monoamines. In this, it contrasts with venlafaxine and duloxetine which, while possessing a dual action, have a selectivity of the order of 30-fold and 10-fold respectively for the reuptake of serotonin. Milnacipran has mainly been launched in countries where the selective serotonin reuptake inhibitors (SSRIs) and venlafaxine had been established for several years. As such it has attracted relative little interest from clinician investigators as a research tool. Japan, however, represents a unique situation because in 1999 milnacipran was launched within months of the first SSRI and is still the only SNRI in Japan together with only two SSRIs (a third has just been introduced). This has led to a large number of investigative clinical studies, many of which give interesting insights into the potential of milnacipran in the treatment of depression and of other disorders. This article reviews these Japanese studies with milnacipran.

Keywords: depression, antidepressants, SNRI, pain

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