Considering the risk/benefit ratio and a high proportion of women discontinuing the psychotropic drugs like milnacipran can be helpful for fibromyalgia syndrome (FMS) treatment during pregnancy, explained in a study published in January in the journal 'Archives of Women's Mental Health'.

In this study, Salvatore Gentile and Maria Luigia Fusco intended to examine the risk/benefit ratio of using psychotropic drugs approved in the USA and EU for FMS treatment during pregnancy. Also, the effectiveness of non-pharmacological interventions was explored for the clinicians to manage FMS in pregnancy in those countries where no drugs are approved for treating this disease.  A literature search was performed on PubMed and Google Scholar following the PRISMA guidelines for systematic reviews. A separate literature search included the three psychotropic drugs approved in the USA for treating FMS, transcranial magnetic stimulation (TMS) and psychotherapy.  The perinatal duloxetine exposure is linked with a high risk of gestational and perinatal complications. As for pregabalin, the available information suggests that the drug is not devoid of structural teratogenicity potential. There is lack of information available for milnacipran.  It is advised that duloxetine and pregabalin should be only given to pregnant women diagnosed with severe forms of FMS after carefully investigating the benefits and risks for the mother-fetus dyad. Also, the proportion of women who discontinued psychotropic drugs during pregnancy is as high as 85.4% needs to be taken into account. This high rate further raises the questions regarding the adequate alternative treatment of FMS during the perinatal period. Neither duloxetine nor milnacipran or pregabalin has been EMEA approved for FMS treatment. 

"The future direction of research in the field should be focused to test psychological treatment of FMS in perinatal women. The data on TMS are also conflicting," noted the study authors.