Levomilnacipran for the treatment of major depressive disorder: a review

Asnis, Gregory M.; Henderson, Margaret A.
January 2015
Neuropsychiatric Disease & Treatment;2015, Vol. 11, p125
Academic Journal
Levomilnacipran (LVM, Fetzima®) was recently approved by the US Food and Drug Administration for the treatment of major depressive disorder. It is a unique dual neurotransmitter reuptake inhibitor. In contrast with other selective serotonin norepinephrine reuptake inhibitors, including duloxetine, venlafaxine, and desvenlafaxine, it has greater selectivity for inhibiting norepinephrine reuptake than serotonin reuptake. Our review focuses on the efficacy, safety, and tolerability data for five double-blind, placebo-controlled, short-term studies and two long-term studies. In the short-term studies, LVM was found to be more effective than placebo in reducing depression (Montgomery-Åsberg Depression Rating Scale) scores as well as improving functional impairment (Sheehan Disability Scale) scores. Long-term studies found LVM to be similarly effective but in the only placebo-controlled long-term study, LVM was not significantly superior to placebo. LVM is fairly well tolerated, with the most common adverse events being nausea, headache, dry mouth, hyperhidrosis, and constipation. Discontinuation rates were mildly increased in those being treated with LVM (9%) versus placebo (3%). Adverse events were not dose-related except for urinary hesitancy and erectile dysfunction. LVM was weight neutral, was not toxic to the liver, and did not cause clinically significant QTc prolongation. Consistent with being a predominant potentiator of norepinephrine, pulse and blood pressure were significantly elevated by LVM but rarely induced tachycardia or hypertension. LVM is a relatively safe alternative antidepressant treatment with minimal drug-drug interactions. It is the only antidepressant that has in its labeling that it is not only effective in improving depression but also effective in improving impaired functioning. Whether this important effect on functioning is unique to LVM must be researched. In addition, whether LVM might be effective in norepinephrine-deficit depression, refractory depression, atypical depression, or seasonal depression is yet to be evaluated. Ultimately, head-to-head studies comparing LVM with other antidepressants will determine the place of LM in antidepressant treatment.


Related Articles

  • What is the State of the Evidence? Thase, Michael E. // Psychiatric Annals;Dec2003, Vol. 33 Issue 12, p813 

    Discusses therapeutic alternatives for difficult-to-treat depression. Treatment algorithms and practice guidelines; Definitions of treatment resistance; Antidepressant combinations that may be utilized.

  • Psicoterapia frente a farmacoterapia en depresión en atención ambulatoria. Güemes, I.; Guillen, V.; Ballesteros, J. // Actas Espanolas de Psiquiatria;sep2008, Vol. 36 Issue 5, p79 

    Depression in Europe has a prevalence rate of 3,9%. One of the main work loads in out-patient care comes from treatment of affective disorders. The objective of the present study is to compare the efficacy of psychotherapy versus drug therapy in the treatment of affective disorders. The...

  • GP frustration over depression therapies. Hairon, Nerys // Pulse;9/10/2005, Vol. 65 Issue 35, p22 

    Reports on the consensus of General Practitioners (GP) against the failure of the NICE guidance to provide access to psychological therapies first-line for mild and moderate depression in Great Britain. Failure to deliver counseling and other psychological therapies; Factors attributed to the...

  • Investigation of Antidepressant Medication Usage after Bariatric Surgery. Cunningham, Julie; Merrell, Cory; Sarr, Michael; Somers, Kristin; McAlpine, Donald; Reese, Michael; Stevens, Susanna; Clark, Matthew // Obesity Surgery;Apr2012, Vol. 22 Issue 4, p530 

    Background: Many patients seeking bariatric surgery have a history of mood disorders and are actively prescribed antidepressants. While extensive documentation exists on the impact of weight loss surgery on reductions in cardiac, diabetic, and hypertensive medications, little is known about the...

  • Tetrahydrobiopterin Pathway may Provide Novel Molecular Targets for Acute and Long Term Efficacy of Mood-Regulating Drugs. McHugh, Patrick C. // Current Pharmacogenomics & Personalized Medicine;Sep2010, Vol. 8 Issue 3, p174 

    Existing treatments for depression usually take several weeks to achieve their antidepressant effects, and a significant number of patients do not have adequate improvement or are treatment refractory even after long-term drug administration. Moreover, the increased risk of suicide is a serious...

  • Treating depression as a recurrent or chronic disease. Glass, Richard M.; Glass, R M // JAMA: Journal of the American Medical Association;1/6/99, Vol. 281 Issue 1, p83 

    Editorial. Discusses the treatment of major depression as a chronic or recurrent lifelong illness. Major depression as a worldwide disease burden; Importance of diagnosing and treating depression effectively; Traits of major depression syndrome; Distinction between bipolar mood disorders and...

  • Efficacy of Group Behavioral Activation Treatment as Supplemental Treatment to Pharmacotherapy in Inpatients with Depressive Disorders. Fereidooni, Samad; Gharaei, Banafsheh; Birashk, Behrooz; Sahraeian, Ali; Davood Hoseini, Seyed Mohammad // Journal of Mood Disorders;2015, Vol. 5 Issue 3, p104 

    Efficacy of group behavioral activation treatment as supplemental treatment to pharmacotherapy in inpatients with depressive disorders Objective: It is important to consider history of dealing with depression as it evolved from pure behavioral approaches that predate behavioral activation....

  • Low blood pressure and risk of depression in the elderly. A prospective community-based study. Paterniti, Sabrina; Verdier-Taillefer, Marie-Hélène; Geneste, Catherine; Bisserbe, Jean-Claude; Alpérovitch, Annick; Paterniti, S; Verdier-Taillefer, M H; Geneste, C; Bisserbe, J C; Alpérovitch, A // British Journal of Psychiatry;May2000, Vol. 176, p464 

    Background: The relationship between depression and low blood pressure in unclear.Aims: To examine the temporal relation between low blood pressure and depression in a two-year follow-up.Method: The study group consisted of 1389 subjects aged 59-71 years;...

  • Effect of rolipram, a phosphodiesterase enzyme type-4 inhibitor, on γ-amino butyric acid content of the frontal cortex in mice exposed to chronic mild stress. Shalaby, Amany Mohamed; Kamal, Sahar Mohamed // Journal of Pharmacology & Pharmacotherapeutics;Apr2012, Vol. 3 Issue 2, p132 

    Objectives: To investigate the alterations in GABA levels by rolipram in the model of depression. Materials and Methods: The alteration of GABA content by rolipram as a phosphodiesterase enzyme type-4 inhibitor in the frontal cortex (FCx; as a brain region crucial for the control of emotion and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics