ClinicalTrials.gg
CompletedNCT02431806Updated Sep 7, 2020Results posted

Safety and Efficacy of Levomilnacipran ER in Adolescent Participants With Major Depressive Disorder

A Phase 3 interventional study of Placebo and Levomilnacipran in Major Depressive Disorder, sponsored by Forest Laboratories. Completed at 49 sites in 2 countries. Open to participants aged 12 Years to 17 Years. Per ClinicalTrials.gov, last updated 2020-09-07.

Sponsored by Forest Laboratories (part of AbbVie) · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
552
Allocation
Randomized
Ages
12 Years to 17 Years
Sex
All
01

Study summary

The purpose of this study is to evaluate the efficacy, safety, and tolerability of levomilnacipran ER relative to placebo in adolescent outpatients (12-17 years) with Major Depressive Disorder (MDD). In addition, the study is designed to obtain pharmacokinetics (PK) data to guide dose selection for future pediatric studies of levomilnacipran.

Read the detailed description

Study LVM-MD-11 is a randomized, double-blind, placebo- and active-controlled, parallel group, fixed-dose study in adolescent patients, ages 12-17 years. The study will be approximately 10 weeks in duration:

  • 1-week screening/washout period
  • 8-week double-blind treatment period
  • 1-week double-blind down-taper period

Participants who meet the eligibility criteria at Visit 2 (Baseline) will be randomized to 1 of 4 treatment groups: placebo, levomilnacipran 40 mg/day, levomilnacipran 80 mg/day, or fluoxetine 20 mg/day.

02

Conditions studied

  • Major Depressive Disorder
03

In context

Depressive Disorder, Major

3,041 studies on the registry are indexed under Depressive Disorder, Major; 588 are open to participants now.

This study's enrollment of 552 is above the median of 79 across 2,530 interventional studies indexed under Depressive Disorder, Major.

Browse Depressive Disorder, Major studies →

Lead sponsor

Forest Laboratories is the lead sponsor of 168 studies on the registry; none are open to participants now.

Of its 6 completed or terminated interventional studies of FDA-regulated products, 6 (100%) have results posted.

First submitted before Forest Laboratories became part of AbbVie.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
12 Years to 17 Years
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Key Inclusion Criteria:

  • Male or female outpatients;12-17 years of age
  • Meet , Fourth Edition, Text Revision (DSM-IV-TR) criteria for MDD, confirmed by Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime (K-SADS-PL)
  • Score ≥ 40 on the Children's Depression Rating Scale-Revised (CDRS-R) at Visits 1 and 2
  • Clinical Global Impressions-Severity (CGI-S) score ≥ 4 at Visits 1 and 2
  • Reliable caregiver
  • Physical examination, vital signs, clinical laboratory tests, and (ECG) normal or not

Key Psychiatric Exclusion Criteria:

  • DSM-IV-TR-based diagnosis of an axis I disorder other than MDD that is the primary focus of treatment
  • Mental retardation or amnestic or other cognitive disorders
  • Significant suicide risk:
  • Suicide attempt within the past year OR
  • Investigator judgment (based on psychiatric interview and Columbia-Suicide Severity Rating Scale (C-SSRS))

Key Treatment-Related Exclusion Criteria:

  • Allergy, intolerance, or to levomilnacipran, milnacipran, fluoxetine, or any other selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRI)
  • Use of prohibited concomitant medication that cannot be discontinued

Other Key Medical Exclusion Criteria:

  • Any current medical condition that might interfere with the conduct of the study, confound the interpretation of study results, or affect participants safety
  • Liver enzyme tests (AST) and/or alanine aminotransferase (ALT) > 2X the (ULN)
  • Clinically significant cardiovascular disorders
  • Seizure disorder or risk of seizure
  • Drug or alcohol abuse or dependence (within the past year)
  • Positive urine drug screen or blood alcohol
Terms in these criteria, in plain language(6)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

DSM diagnostic criteria

The American Psychiatric Association’s manual of mental health diagnoses. DSM-5 (2013, revised as DSM-5-TR in 2022) replaced DSM-IV, and some studies still name the older edition. “Meets DSM criteria for …” means diagnosed by that edition’s diagnostic criteria, usually by a clinician in an interview.

ECG (electrocardiogram)

A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
552 participants (actual)

Study arms

  • Placebo comparator
    Placebo

    Participants received 2 dose matched over-encapsulated placebo capsules, once daily, orally during the Double-blind Treatment Period up to 8 weeks followed by a 1 week Taper-down Period if applicable as determined by the investigator.

    Drug: Placebo

  • Experimental
    Levomilnacipran 40 mg

    Participants received over-encapsulated levomilnacipran extended release (ER) 40 mg/day capsules orally starting at a dose of 10 mg/day on Day 1-2, 20 mg/day on Days 3-7 and 40 mg/day on Week 2 through Week 8 during the Double-Blind Treatment Period, followed by a 1-week Double-Blind Taper-down Period if applicable as determined by the investigator. Participants received 1 dose matched placebo capsule each day to maintain the blind.

    Drug: Levomilnacipran

  • Experimental
    Levomilnacipran 80 mg

    Participants received over-encapsulated levomilnacipran ER two 40 mg/day capsules (80 mg/day) orally starting at a dose of 10 mg/day on Day 1-2, 20 mg/day on Day 3-4, 40 mg/day on Day 5-7 and 80 mg/day on Week 2 through Week 8 during the Double-blind Treatment Period, followed by a 1-week Double-blind Taper-down Period if applicable as determined by the investigator. Participants received 1 dose matched placebo capsule the first week and during the taper-down period to maintain the blind.

    Drug: Levomilnacipran

  • Active comparator
    Fluoxetine 20 mg

    Participants received over-encapsulated fluoxetine 20 mg/day tablets orally starting at a dose of 10 mg/day in Week 1 and 20 mg/day in Week 2 through Week 8 during the Double-blind Treatment Period, followed by a 1-week Double-blind Taper-down Period if applicable as determined by the investigator. Participants received 1 dose matched placebo capsule each day to maintain the blind.

    Drug: Fluoxetine

Interventions

  • DrugPlacebo

    Matched over-encapsulated placebo capsules administered orally on Day 1 to Week 8.

  • Over-encapsulated levomilnacipran ER capsules administered orally on Day 1 to Week 8.

    Also known as: Fetzima

  • Over-encapsulated fluoxetine tablets administered orally on Day 1 to Week 8.

    Also known as: Prozac

06

What researchers measure

Primary outcomes

  1. Change From Baseline in Children's Depression Rating Scale-Revised (CDRS-R) Total Score

    CDRS-R is a 17-item scale measuring presence and severity of symptoms commonly associated with childhood depression and is scored on a 1-to-5- or 1-to-7-point scale. Rating of 1 indicates normal function. The CDRS-R total score ranges from 17 to 113; higher score indicates more severe depression. A negative change from Baseline indicates improvement. Mixed Model for Repeated Measures (MMRM) was used for analysis.

    Time frame: Baseline (Week 0) to Week 8

Secondary outcomes

  1. Change From Baseline in Clinical Global Impression-Severity (CGI-S) Scale

    The CGI-S is a clinician-rated scale used to rate the severity of the participants current state of mental illness compared with MDD population. The participant was rated on a scale from 1 to 7, where 1= Very much improved; 2= Much improved; 3= Minimally improved; 4= No change; 5= Minimally worse; 6= Much worse; 7= Very much worse. Higher score indicates worsening of mental illness. A negative change from Baseline indicates improvement. MMRM was used for analysis.

    Time frame: Baseline (Week 0) to Week 8

07

Results

Posted Sep 7, 2020

Participant flow

Double-blind Treatment Period
Participant flow — Double-blind Treatment Period
MilestonePlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/Day
Started142136139135
Safety population141134138134
Completed117115107109
Not completed25213226
Withdrew: Did not receive treatment1211
Withdrew: Adverse event47117
Withdrew: Lack of efficacy2022
Withdrew: Withdrawal of consent10755
Withdrew: Lost to follow-up7458
Withdrew: Investigational product non-compliance1031
Withdrew: Reason not specified0152
Double-blind Down-taper Period
Participant flow — Double-blind Down-taper Period
MilestonePlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/Day
Started111109104107
Completed111109104107
Not completed0000

Outcome measures

PrimaryChange From Baseline in Children's Depression Rating Scale-Revised (CDRS-R) Total Score

CDRS-R is a 17-item scale measuring presence and severity of symptoms commonly associated with childhood depression and is scored on a 1-to-5- or 1-to-7-point scale. Rating of 1 indicates normal function. The CDRS-R total score ranges from 17 to 113; higher score indicates more severe depression. A negative change from Baseline indicates improvement. Mixed Model for Repeated Measures (MMRM) was used for analysis.

Time frame:
Baseline (Week 0) to Week 8
Reported as:
Least squares mean · score on a scale
Change From Baseline in Children's Depression Rating Scale-Revised (CDRS-R) Total Score
score on a scalePlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/Day
Change From Baseline in Children's Depression Rating Scale-Revised (CDRS-R) Total Score-22.90 ± 1.09-23.28 ± 1.11-22.64 ± 1.12-24.37 ± 1.12
Statistical analysis
  • Placebo vs Levomilnacipran 40 mg/Day · Mixed Model Repeated Measures (MMRM) · p = 0.8035 · Least squares (ls) mean difference: -0.38 · 95% CI -3.41 to 2.64Estimates and p-values are based on MMRM with treatment group, pooled study center, visit, and treatment group-by-visit interaction as fixed effects, and baseline and baseline-by-visit as covariates using an unstructured covariance matrix.
  • Placebo vs Levomilnacipran 80 mg/Day · MMRM · p = 0.8681 · Ls mean difference: 0.26 · 95% CI -2.80 to 3.31Estimates and p-values are based on MMRM with treatment group, pooled study center, visit, and treatment group-by-visit interaction as fixed effects, and baseline and baseline-by-visit as covariates using an unstructured covariance matrix.
  • Placebo vs Fluoxetine 20 mg/Day · MMRM · p = 0.3439 · Ls mean: -1.47 · 95% CI -4.52 to 1.58Estimates and p-values are based on MMRM with treatment group, pooled study center, visit, and treatment group-by-visit interaction as fixed effects, and baseline and baseline-by-visit as covariates using an unstructured covariance matrix.
SecondaryChange From Baseline in Clinical Global Impression-Severity (CGI-S) Scale

The CGI-S is a clinician-rated scale used to rate the severity of the participants current state of mental illness compared with MDD population. The participant was rated on a scale from 1 to 7, where 1= Very much improved; 2= Much improved; 3= Minimally improved; 4= No change; 5= Minimally worse; 6= Much worse; 7= Very much worse. Higher score indicates worsening of mental illness. A negative change from Baseline indicates improvement. MMRM was used for analysis.

Time frame:
Baseline (Week 0) to Week 8
Reported as:
Least squares mean · score on a scale
Change From Baseline in Clinical Global Impression-Severity (CGI-S) Scale
score on a scalePlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/Day
Change From Baseline in Clinical Global Impression-Severity (CGI-S) Scale-1.54 ± 0.10-1.52 ± 0.10-1.52 ± 0.10-1.68 ± 0.10
Statistical analysis
  • Placebo vs Levomilnacipran 40 mg/Day · MMRM · p = 0.8788 · Ls mean difference: 0.02 · 95% CI -0.25 to 0.29Estimates and p-values are based on MMRM with treatment group, pooled study center, visit, and treatment group-by-visit interaction as fixed effects, and baseline and baseline-by-visit as covariates using an unstructured covariance matrix.
  • Placebo vs Levomilnacipran 80 mg/Day · MMRM · p = 0.9230 · Ls mean difference: 0.01 · 95% CI -0.26 to 0.29Estimates and p-values are based on MMRM with treatment group, pooled study center, visit, and treatment group-by-visit interaction as fixed effects, and baseline and baseline-by-visit as covariates using an unstructured covariance matrix.
  • Placebo vs Fluoxetine 20 mg/Day · MMRM · p = 0.2895 · Ls mean difference: -0.15 · 95% CI -0.42 to 0.13Estimates and p-values are based on MMRM with treatment group, pooled study center, visit, and treatment group-by-visit interaction as fixed effects, and baseline and baseline-by-visit as covariates using an unstructured covariance matrix.

Adverse events

Collected over First dose of study treatment to end of study follow-up (Up to 10 Weeks). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Placebo0/141 (0%)0/141 (0%)33/141 (23.4%)
Levomilnacipran 40 mg/Day0/134 (0%)2/134 (1.5%)54/134 (40.3%)
Levomilnacipran 80 mg/Day0/138 (0%)0/138 (0%)63/138 (45.7%)
Fluoxetine 20 mg/Day0/134 (0%)4/134 (3%)41/134 (30.6%)
Most frequent serious events
Most frequent serious events
EventPlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/Day
OverdoseInjury, poisoning and procedural complications0/1411/1340/1380/134
Intentional overdoseInjury, poisoning and procedural complications0/1410/1340/1381/134
Suicide attemptPsychiatric disorders0/1411/1340/1381/134
Suicidal ideationPsychiatric disorders0/1410/1340/1381/134
FaecalomaGastrointestinal disorders0/1410/1340/1381/134
Most frequent other events
Most frequent other events
EventPlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/Day
NauseaGastrointestinal disorders8/14119/13422/1385/134
HeadacheNervous system disorders15/14120/13419/13813/134
TachycardiaCardiac disorders1/14113/13412/1385/134
VomitingGastrointestinal disorders3/14111/13411/1384/134
Decreased appetiteMetabolism and nutrition disorders2/1417/1349/13810/134
DizzinessNervous system disorders5/1415/1349/1383/134
SomnolenceNervous system disorders3/1416/1348/1382/134
NasopharyngitisInfections and infestations3/1414/1347/1387/134
Abdominal pain upperGastrointestinal disorders4/1416/1347/1384/134

Baseline characteristics

Safety Population included all participants in the Randomized Population who took at least 1 dose of double-blind investigational product.

Age, Continuous
Age, Continuous(years)PlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/DayTotal
Mean14.3 ± 1.5914.8 ± 1.6214.8 ± 1.7514.7 ± 1.6714.7 ± 1.67
Sex: Female, Male
Sex: Female, Male(Participants)PlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/DayTotal
Female98948784363
Male43405150184
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)PlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/DayTotal
Hispanic or Latino33363236137
Not Hispanic or Latino1089810698410
Unknown or Not Reported00000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)PlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/DayTotal
American Indian or Alaska Native10113
Asian11114
Native Hawaiian or Other Pacific Islander01001
Black or African American52464940187
White81818388333
More than one race643417
Unknown or Not Reported01102
Children's Depression Rating Scale-Revised (CDRS-R) Total Score
Children's Depression Rating Scale-Revised (CDRS-R) Total Score(score on a scale)PlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/DayTotal
Mean61.1 (40 to 83)61.8 (32 to 88)59.4 (41 to 81)61.5 (40 to 92)60.95 (32 to 92)
Clinical Global Impression-Severity (CGI-S) Scale
Clinical Global Impression-Severity (CGI-S) Scale(score on a scale)PlaceboLevomilnacipran 40 mg/DayLevomilnacipran 80 mg/DayFluoxetine 20 mg/DayTotal
Mean4.7 (4 to 6)4.8 (3 to 6)4.7 (4 to 6)4.7 (4 to 6)4.7 (3 to 6)
08

Study locations

49 sites
  • Harmonex, Inc
    Dothan, Alabama 36303, United States
  • University of Arizona Department of Psychiatry
    Tucson, Arizona 85724, United States
  • Advanced Research Center, Inc.
    Anaheim, California 92801, United States
  • ProScience Research Group
    Culver City, California 90230, United States
  • Sun Valley Research Center
    Imperial, California 92251, United States
  • Alliance for Research
    Long Beach, California 90807, United States
  • Asclepes Research Centers
    Panorama City, California 91402, United States
  • Syrentis Clinical Research
    Santa Ana, California 97025, United States
  • Pacific Clinical Research Medical Group
    Upland, California 91786, United States
  • MCB Clinical Research Center
    Colorado Springs, Colorado 80910, United States
  • Florida Clinical Research Center; LLC
    Bradenton, Florida 34201, United States
  • Coastal Clinical Research Specialists
    Fernandina Beach, Florida 32034, United States
  • Gulfcoast Clinical Research Center
    Fort Myers, Florida 33912, United States
  • Research in Miami Inc
    Hialeah, Florida 33013, United States
  • Advanced Research Institute of Miami
    Homestead, Florida 33030, United States
  • Clinical Neuroscience Solutions, Inc.
    Jacksonville, Florida 32256, United States
  • Innovative Clinical Research, Inc.
    Lauderhill, Florida 33319, United States
  • Medical Research Group of Central Florida
    Orange City, Florida 32763, United States
  • Clinical Neuroscience Solutions, Inc.
    Orlando, Florida 32801, United States
  • University of South Florida Board of Trustee
    Tampa, Florida 33613, United States
  • Atlanta Center for Medical Research
    Atlanta, Georgia 30331, United States
  • Institute for Behavioral Medicine
    Smyrna, Georgia 30080-2620, United States
  • Clinical Research Institute
    Stockbridge, Georgia 30281, United States
  • Sandeep Gaonkar, MD
    Naperville, Illinois 60563, United States
  • NeuroMedical Institute
    Panama City, Illinois 32405, United States
  • Kentucky Pediatric Research
    Bardstown, Kentucky 40004, United States
  • Adams Clinical Trials, LLC
    Watertown, Massachusetts 02472, United States
  • Alivation Research
    Lincoln, Nebraska 68526, United States
  • Kolade Research Institute
    Las Vegas, Nevada 89102, United States
  • Healthy Perspectives - Innovative Mental Health Services. PLLC
    Nashua, New Hampshire 03060, United States
  • Princeton Medical Institute
    Princeton, New Jersey 08540, United States
  • Manhattan Behavioral Medicine
    New York, New York 10036, United States
  • Midwest Clinical Research Center
    Dayton, Ohio 45417, United States
  • Professional Psychiatric Services
    Mason, Ohio 45040, United States
  • IPS Research Company
    Oklahoma City, Oklahoma 73106, United States
  • Sooner Clinical Research
    Oklahoma City, Oklahoma 73112, United States
  • Cutting Edge Research Group
    Oklahoma City, Oklahoma 73116, United States
  • Paradigm Research Professionals
    Oklahoma City, Oklahoma 73118, United States
  • Tulsa Clinical Research, LLC
    Tulsa, Oklahoma 74104, United States
  • Oregon Center for Clinical Investigations, Inc.
    Salem, Oregon 97301, United States
  • UTHSC-Houston
    Houston, Texas 77054, United States
  • Bay Area Clinical Services dba Earle Research
    Houston, Texas 77058, United States
  • Red Oak Psychiatry Associates
    Houston, Texas 77090, United States
  • Family Psychiatry of The Woodlands
    The Woodlands, Texas 77381, United States
  • UVA Child and Family Psychiatry Clinic
    Charlottesville, Virginia 22903, United States
  • Carilion Medical Center
    Roanoke, Virginia 24014, United States
  • Northwest Clinical Research Center
    Bellevue, Washington 98007, United States
  • Eastside Therapeutic Resource dba Core Clinical
    Everett, Washington 98201, United States
  • INSPIRA Clinical Research
    San Juan, 00918, Puerto Rico
09

References and documents

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: Undecided

10

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Jun 2015 to primary completion in Aug 2019, 49 months.

Results were first posted in Sep 2020, 1 year after primary completion.

Of 95 industry-sponsored phase 3 interventional studies under Depressive Disorder, Major, half reached primary completion within 26 months of starting (the median), counting those still running; a quarter within 20 and three quarters within 33. This study's 49 months is above that.

Counting every sponsor, half of 124 studies reached it within 27 months; a quarter within 21 and three quarters within 36.

How these figures are worked out, and which studies are left out of them.

Registered
Apr 28, 2015
First posted
May 1, 2015
StartActual
Jun 23, 2015
Primary completionActual
Aug 19, 2019
CompletionActual
Aug 19, 2019
Results first posted
Sep 7, 2020
Last update
Sep 7, 2020
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 7, 2020, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02431806
Responsible party
Sponsor
First posted
May 1, 2015
Start date
Jun 23, 2015
Primary completion
Aug 19, 2019
Completion
Aug 19, 2019
Results posted
Sep 7, 2020
Last update
Sep 7, 2020

Study contacts

Daniel Radecki
study director · Forest Research Institute, Inc., an affiliate of Allergan, plc

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Levomilnacipran

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