Effect of milnacipran on suicidality in patients with mild to moderate depressive disorder

The presence of suicidal manifestations (thoughts and behavior) was studied in a cohort of 30 patients with mild to moderate depression during a 6-week treatment with the serotonin-norepinephrine reuptake inhibitor, milnacipran. At baseline mild suicidal thoughts were present in 46.7% of patients, the mean Hamilton Depression Rating Score (HDRS(17)) was 23.9 +/- 1.8 and the mean suicidality score on the Beck Scale for Suicidal Ideation (BSS) was 4.9 +/- 4.9. Suicidal thoughts decreased progressively throughout the study in parallel with other depressive symptoms. At no time during treatment was there any indication of an increased suicidal risk. Notably, the items retardation and psychic anxiety on the HDRS(17) decreased in parallel. This may possibly explain the lack of any "activation syndrome", which is occasionally observed at the early stages of therapy with some antidepressants and may be linked to a temporary increase in suicidal ideation. To our knowledge this is the first detailed report of suicidality during treatment with milnacipran.