Treatment of old - age patients requires antidepressants with high efficacy, but safety from view of pharmacokinetics and pharmacodynamics.

Milnacipran is a specific serotonin and noradrenaline reuptake inhibitor antidepressant, which is devoid of antagonist activity at muscarinic, histamine and adrenergic receptors, resulting in a benign side-effect profile.

evaluate efficacy and tolerability of milnacipran over a 8 -week treatment period in patients older 60 years suffering from reccurent or single episode of major depression.

24 patients with mild or moderate major depression were included in the study. Patients had been suffering from depression from 2 to 20 years and had had one or two depressive episodes in the last two years. The study was open label. Milnacipran was administered as a single daily dose of 50 mg and subsequently as 50 mg bid (100 mg/day).

After six weeks all patients had a reduction of the Hamilton score of at least 40% with a mean reduction of 54.6%. After eight weeks, the mean Hamilton rating score was 8.1 with most patients in remission with a score of 8 or less. Adverse events were reported infrequently. Constipation and excessive sweating occurred in four patients and headache in one patient. These adverse events occurred early in the treatment and lasted less than 14 days.

Good efficacy and good tolerance suggests that milnacipran is a suitable candidate for first line treatment of mild to moderate major depression.