{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T05:49:14Z","timestamp":1777268954145,"version":"3.51.4"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Evidence on milnacipran exposure during pregnancy is sparse, complicating treatment decisions when maternal stability depends on this antidepressant. We report a 31-year-old primigravida with severe post-traumatic stress disorder and a severe major depressive episode with psychotic features in the context of a chronic, difficult-to-treat psychiatric course marked by self-harm, dissociation, and recurrent suicidal behavior. Milnacipran 150 mg\/day led to marked clinical improvement before pregnancy. After pregnancy confirmation, treatment was changed to sertraline plus quetiapine because of limited pregnancy safety data, but depressive symptoms and suicidal behavior reemerged within 2 weeks. Milnacipran was therefore re-established after risk-benefit evaluation and shared decision-making, with renewed improvement. Moderate hyperemesis gravidarum during the second trimester led to discontinuation of milnacipran by gestational week 22. Delivery occurred at gestational week 38 via primary cesarean section. No congenital anomalies or neonatal adaptation problems were observed. At 3-year follow-up, pediatric developmental screenings remained within expected limits. This case illustrates the challenge of balancing relapse risk, prior treatment response, and treatment feasibility during pregnancy when evidence for the effective medication is limited.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1830520","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T05:27:02Z","timestamp":1777267622000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Milnacipran continuation during pregnancy in a patient with severe post-traumatic stress disorder and psychotic depression: a case report with 3-year pediatric follow-up"],"prefix":"10.3389","volume":"17","author":[{"given":"Maximilian","family":"Preiss","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna","place":["Vienna, Austria"]},{"name":"Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna","place":["Vienna, Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucie","family":"Bartova","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna","place":["Vienna, Austria"]},{"name":"Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna","place":["Vienna, Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"403","DOI":"10.4088\/jcp.19r13134","article-title":"The risk of relapse of depression during pregnancy after discontinuation of antidepressants: A systematic review and meta-analysis","volume":"81","author":"Bayrampour","year":"2020","journal-title":"J Clin Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.10.069","article-title":"Discontinuation and re-initiation of antidepressants during pregnancy: A nationwide cohort study","volume":"298","author":"Noh","year":"2022","journal-title":"J Affect Disord"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2019.06.007","article-title":"Impact of antidepressant use, discontinuation, and dosage modification on maternal depression during pregnancy","volume":"29","author":"B\u00e9rard","year":"2019","journal-title":"Eur Neuropsychopharmacol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmr.2025.100046","article-title":"Safety in treatment: Classical pharmacotherapeutics and new avenues for addressing maternal depression and anxiety during pregnancy","volume":"77","author":"Dagher","year":"2025","journal-title":"Pharmacol Rev"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000005202","article-title":"Treatment and management of mental health conditions during pregnancy and postpartum: ACOG clinical practice guideline no. 5","volume":"141","year":"2023","journal-title":"Obstet Gynecol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2024.01.010","article-title":"Impact of genetic, sociodemographic, and clinical features on antidepressant treatment trajectories in the perinatal period","volume":"81","author":"Liu","year":"2024","journal-title":"Eur Neuropsychopharmacol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1359539","article-title":"Editorial: Long term effects of prenatal exposure to medications and vaccines","volume":"15","author":"van Gelder","year":"2024","journal-title":"Front Pharmacol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"199525","DOI":"10.4088\/jcp.24m15633","article-title":"Incidence and risk factors for suicide attempt during pregnancy and the postpartum period","volume":"86","author":"Goldman-Mellor","year":"2025","journal-title":"J Clin Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.3390\/jcm15041629","article-title":"Integrating psychiatric, psychotherapeutic, and nursing care in intranasal esketamine for treatment-resistant depression","volume":"15","author":"Martiadis","year":"2026","journal-title":"J Clin Med"},{"key":"B10","first-page":"55","volume-title":"Savella\u00ae Pregnancy registry (MLN-MD-30 \/ CMO-EPI-NEU-0539): clinical study report synopsis. Version 1.0","year":"2025"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1588902","article-title":"Editorial: Treatment resistant depression (TRD): epidemiology, clinic, burden and treatment","volume":"16","author":"Fiorillo","year":"2025","journal-title":"Front Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1299368","article-title":"Cariprazine augmentation in patients with treatment resistant unipolar depression who failed to respond to previous atypical antipsychotic add-on. A case-series","volume":"14","author":"Pessina","year":"2023","journal-title":"Front Psychiatry"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/s0957-5847(97)80092-3","article-title":"The management of nausea and vomiting in pregnancy and hyperemesis gravidarum (Green-top Guideline No. 69)","volume":"131","author":"Nelson-Piercy","year":"2024","journal-title":"BJOG"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocpiqo.2023.02.002","article-title":"Poor neonatal adaptation after antidepressant exposure during the third trimester in a geographically defined cohort","volume":"7","author":"Brumbaugh","year":"2023","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"B15","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1002\/ijgo.70165","article-title":"The impact and management of hyperemesis gravidarum: Current and future perspectives","volume":"171","author":"van der Minnen","year":"2025","journal-title":"Int J Gynaecol Obstet"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1830520\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T05:27:03Z","timestamp":1777267623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1830520\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":15,"alternative-id":["10.3389\/fpsyt.2026.1830520"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1830520","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"article-number":"1830520"}}