Suicidal Idealtion

• Milnacipran is a selective serotonin and norepinephrine re-uptake inhibitor (SNRI), similar to some drugs used for the treatment of depression and other psychiatric disorders.
• Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
• Anyone considering the use of such drugs in a child, adolescent, or young adult must balance this risk with the clinical need.
• Short term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in   age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older.
• Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.
• Patients of all ages who are started on milnacipran should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.
• Families and caregivers should be advised of the need for close observation and communication with the prescriber.
• Milnacipran is not approved for use in the treatment of major depressive disorder. Milnacipran is not approved for use in pediatric patients.