Antidepressants clinical uses

Many patients are excluded from clinical trials. Critics of our meta-analysis have suggested that antidepressants might work better for these patients than they do for those who are studied in clinical trials. Let us see how plausible this concern is. 

The agency also provided us with a meta-analysis that showed that the estimated efficacy of antidepressants in children was minimal and likely to have been overestimated, because published studies have much more favorable results than unpublished studies. Thus, both clinical experience and published trials are likely to lead to inflated estimates of the efficacy of these drugs. 

Milnacipran, although relatively new on the market in the USA, has been in use in Europe since 1996. It was first approved for the treatment of major depression in France in December 1996 and is currently marketed under the brand name Ixel in over 45 countries worldwide and under the brand name Toledomin in Japan. Milnacipran has been compared to imipramine, SSRIs, TCAs, and additional antidepressant medications. When comparing milnacipran with TCAs, both are equally efficacious however, significantly fewer side effects were experienced with milnacipran. As with other antidepressant medications, 1 to 3 weeks may elapse before significant antidepressant action becomes clinically evident. In January 2009 the US Food and Drug Administration (FDA) approved milnacipran (under the brand name Savella) for the treatment of fibromyalgia, making it the third medication approved for this purpose in the USA. 

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