Milnacipran is like venlafaxine and duloxetine an antidepressant from the group of serotonin-norepinephrine reuptake inhibitors (SNRI). In contrast to the other two representatives of this group, this psychotropic drug binds equally to serotonin and norepinephrine transporters and thus leads to an increase of the respective neurotransmitter. In the US, milnacipran is used to treat fibromyalgia syndrome, while in Europe it is approved for the treatment of depression. Milnacipran has special properties due to its pharmacokinetics and pharmacodynamics. This includes a drive-enhancing effect, the improvement of social and sexual function, a favorable side-effect profile and a lack of CYP450 interaction. This article explains the molecular and clinical effects as well as side-effects and interactions of milnacipran. It also addresses the indication and possible dosage schedules for milnacipran. Finally, two cases are presented. This work shows a practical presentation on the pharmacology and the potential use of milnacipran.