Milnacipran (Ixel)

<p>From: Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia

Milnacipran inhibits the reuptake of serotonin and norepinephrine with a much greater effect on the latter. The mode of action is similar to tricyclic antidepressants, but milnacipran is much more selective and thus better tolerated. Milnacipran can be effective for both fatigue and pain. One study also found it effective for the cognitive dysfunction associated with post–stroke depression.77

Two double–blind studies have evaluated the use of milnacipran in fibromyalgia with good results. In the first study 75% of patients in the treatment group reported improvement, compared with only 38% in the placebo arm.78 Pain, fatigue, mood and sleep were all improved.

Another study got similar results and actually found the drug more effective in the group of non–depressed patients.79

Milnacipran is one of the best–tolerated antidepressants. Possible side effects include dizziness, sweating, itching, nausea, anxiety, hot flashes and painful urination. Milnacipran can also worsen orthostatic hypotension, even though like venlafaxine it can sometimes elevate blood pressure.

Milnacipran is currently available in some European countries. It will probably be available in the United States and Canada in the near future. It is one of the least expensive noradrenergic drugs.

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