Levomilnacipran

Brand Name: 

Fetzima

Drug Class: 

Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)

How it works:

Boosts the effects of two neurotransmitters found in the brain called serotonin and norepinephrine.

What makes it unique:

This medication has greater increases in the effect of Norepinephrine over Serotonin. Its sister drug, Milnacipran, is used for pain in fibromyalgia but not for depression. The higher effects of Norepinephrine may make this medication good at treating neuropathic pain.

Side effects:

Headaches and stomach aches are common when starting, but then often goes away. Sexual dysfunction can also occur. Blood pressure can be increased with this medication, especially as the dose increases. An increase in sweating seems to be more common with this medication. Levomilnacipran can also cause urinary retention, tachycardia, and sedation.

Rare side effects include seizures, induction of mania, and activation of suicidal ideation.

How effective is it:

I could not find any trials comparing Levomilnacipran to other antidepressants as it is a newer medication.

(1) A study compared Levomilnacipran to placebo. Data was pooled from 5 trials. Levomilnacipran slightly beat placebo in decreasing the MADRS scale. Levomilnacipran decreased the score by 15.8 as compared to 12.9 in the placebo group. Response rate was only slightly higher as well. 44.7% of patients treated with Levomilnacipran responded as compared to 34.5% in the placebo group. Remission rate was 27.7% in the Levomilnacipran group as compared to 21.5% in the placebo group.

(2) An analysis of 5 studies was conducted to evaluate the effects of Levomilnacipran on noradrenergic symptoms of depression, such as fatigue, and anxiety-related symptoms. Levomilnacipran improved functional impairment mainly through improvements in noradrenergic symptoms and less so via anxiety symptoms.

Clinical experience:

This medication is very rarely seen. When a prescriber requests this medication, it usually raises an eyebrow or both. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.

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References:

1. Montgomery SA, Gommoll CP, Chen C, et al. Efficacy of levomilnacipran extended-release in major depressive disorder: pooled analysis of 5 double-blind, placebo-controlled trials. CNS Spectr. 2015 Apr;20(2):148-56.

2. Blier P, Gommoll C, Chen C, et al. Effects of levomilnacipran ER on noradrenergic symptoms, anxiety symptoms, and functional impairment in adults with major depressive disorder: Post hoc analysis of 5 clinical trials. J Affect Disord. 2017 Mar 1;210:273-279.