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Milnapricin For ME/CFS: more than an antidepressant


Phoenix Rising Founder
This review suggests that Milnapricin in different. It is called an anti-depressant but it has (like some other anti-depressants and anti-anxiety drugs) effects on other than depression. Milnapricin, for instance, is now prescribed for the pain in FM. But what about energy? This review suggests that it may be helpful in treating fatigue.

Milnacipran is a serotonin and norepinephrine reuptake inhibitor (SNRI) with negligible effects on any presynaptic or postsynaptic receptors. Milnacipran has unique pharmacokinetic and pharmacodynamic characteristics that distinguish it from the other marketed serotonin and norepinephrine reuptake inhibitors, venlafaxine, desvenlafaxine, and duloxetine

Moreover, evidence suggests that milnacipran is effective and tolerable in the treatment of fibromyalgia and may have usefulness for fatigue and anxiety symptoms.

Unfortunately they screwed up in the end of the paper lumping in FM with other psychiatric disorders:

The current paper reviews researches conducted to date that is relevant to the efficacy, tolerability, and mechanism of action of milnacipran in the treatment of depression, fibromyalgia, and other psychiatric syndromes.

Still it's interesting how drugs like this seem to affect many different symptoms. They are more than just 'anti-depressants'. Anyone tried milnapricin?

I take clonazepam(klonopin- 5 mg at nite ) -- for years -- this was given to me for fibromyalgia and after I had a sleep study - by a psychiatrist who is a sleep specialist and knows about fibro and cfids

I take st johns wort- only 1 a day when i am feeling really fatigued and down and it does help me with increasing energy

as usual start slow--incidentally it does have antiviral properties too-

obviously, i need to take my clonazepam and go to sleep - but these forums are just too interesting!



Moderation Resource Albuquerque
I have not tried Milnapricin due to cost, but did have good results with cymbalta after tortuously titrating it up from about a tenth of the recommended dose. My dysautonomia specialist often prescribes cymbalta for OI, (and keeps patients at the lowest dose, not the one recommended for depression) and often prescribes it in combo with strattera (a norepinephrine reup inhibitor. They worked for me with OI and the cymbalta helped excitotoxicity a great deal. Gave it up due to cost and potential toxicity.

I researched each of the norep/seratonin reup inhibitors and there is great variation in the proportions of the 2 neurotransmitters that have their reup inhibited. This was very interesting as we tend to think that each of the several might be equivalent--not so!

I also decided to try hypericum (St John's Wort) and got it from a compounding pharmacy as it is known that the bioactive ingredients vary tremendously in Health Food Store brands. It should have worked! But unfortunately gave me migraines! :confused:

Wish Milnapricin didn't cost so much!



Milnacipran (Savella) & CFS

My MD gave me a bunch of Savella samples today & wants me to try it out. I've been diagnosed with CFS & Fibro, but its the CFS that's my disabling problem. I've spent the afternoon trying to find info from anyone with CFS who's tried the Savella. If I do try it, I'm willing to post my progress with it as I use it. . .


Senior Member
I started Savella just over a week ago, and am keeping my fingers crossed that I can continue both physically and financially to take it.

In the last couple of years I have become ridiculously sensitive to meds and some supplements, and if something even works at the beginning, I end up becoming unable to take it due to migraines, vomiting, itching, nasty mood swings, etc. This list includes (but not complete, I need to keep better records): cymbalta, lyrica, lamictal (that helped the sensory overload a lot), ambien, tramadol, etc.

I have not titrated from the minimum dose in these 8 days, because I am feeling less pain and somewhat less fatigue. I just don't want to chance having a reaction and may just stay at this dose. I'm having some itching but it seems to be subsiding some. Nausea at the beginning but was able to deal with it with ginger. Although I've felt some fatigue improvement, the post exertional stuff rears it head just the same.

It is so nice to at least not feel totally crappy all day every day.

My current Medicare Part D provider covers this (at $68) but is dropping it for next year, so I'll have to change companies again. I have had to every single year, and I'm only taking oxycontin (have to have the brand, generic makes me itch and doesn't work as well for me) and generic Zanaflex (anti spasmodic), and migraine med.

My report for now :)

also, fwiw, my doc told me that it is not labeled for depression in the US -


Senior Member
I've been trying this for the past couple of weeks, so far with mostly positive results. I'd prefer not to get into details, but if anyone wants to contact me through the forum, feel free; like anything else, I have no doubt this is not going to be for everyone. Nothing is, but there are definitely side effects that I've been dealing with. But, so far I'd have to say it's worth it.
Is Milnacipran safe to take w Cymbalta? I know some people like to combo it with SSRIs and Vyvanse/stims but I wonder if a 1:10 norepinephrine to serotonin ratio SNRI like Cymbalta would be fine? I am having some partial results and partial improvements with Milnacipran + Vyvanse but still need tremendous work. Motivation, interest, clarity of thought are still largely lacking.

I btw have low thyroid, very low cortisol (adrenal problems), low Testosterone, low estrogen, poor physical + mental energy, very low motivation, and often foggy and thoughtless mind. Also find it extremely difficult to communicate effectively and speak to people.

Milanipran is said to help thyroid and adrenals but that those effects take possibly months to come into effect. So far low doses of 4-8mg have had some benefits towards subtle motivation and tiny desire to engage in a few things but overall still very anhedonic. Higher doses made me feel very robotic and not right.