Milnacipran is the first in a new class of antidepressants known as Norepinephrine Serotonin Reuptake Inhibitors (or NSRI's).              to order

What makes Milnacipran different from the SSRI drugs like ProzacŪ and SNRI antidepressant types like Effexor, is that Milnacipran affects two neurotransmitters - norepinephrine and serotonin - almost equally (a 3:1 norepinephrine to serotonin balance). In contrast an SNRI, tends to act much more on serotonin than norepinephrine, (Effexor has a 1:30 norepinephrine to serotonin ratio).

It is this essentially "equal" potency that makes Milnacipran a promising treatment for chronic pain conditions like Fibromyalgia and Lupus. This is because it is believed that the combination of norepinephrine and serotonin has an analgesic, (pain-killing) effects. The second generation, Tricyclic antidepressants (TCA's), like Amitriptyline (which has a 1.6:1 norepinephrine to serotonin balance), have a proven record in treating chronic pain. Unfortunately, the TCA medications are also known for having more negative side-effects than the SSRI and SNRI antidepressants which have followed them. It is hoped that the newer antidepressants like Milnacipran will be able to affect multiple pain mechanisms in a manner similar to that seen with some tricyclic antidepressants, but without the negative side effects of the TCA's.

Milnacipran not only inhibits the reuptake of Serotonin, it also has an action to inhibit the uptake of Noradrenaline. Both these factors have been shown to be efficacious in the treatment of depression.

However, most SSRIs have some particular side effects that are not welcome. The most common being an increase in the prevalence of erectile dysfunction, or a decrease in libido (sex drive). These effects have not been noted with Milnacipran, which is why it has been receiving a lot of attention as a "new kind" of anti-depressant. In fact, Milnacipran appears to be as effective as the tri-cyclic anti-depressants whilst having fewer side effects than most SSRIs.

Dosages for depression are usually in the order of 25mg to 50mg daily, (maximum 100mg). Like most anti-depressants there are contraindications with other anti-depressants and MAO inhibiting drugs, these would include Gerovital-H3, Deprenyl and Manerix etc., therefore combined use is not advised, (unless under the guidance of a physician). Furthermore, we would not advise combination with other Serotonin or Noradrenaline enhancing agents such as Adrafinil, Modafinil, Paxil, Prozac, Yohimbine and Zoloft etc., (unless you are under the guidance of a physician).

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