Tolerability and efficacy are important factors affecting the clinical choice of an antidepressant agent. Currently available agents such as the tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) have some shortcomings and there may be a need for a new alternative which combines good clinical efficacy with a benign tolerability profile. At the 10th Congress of the European College of Neuropsychopharmacology [Vienna, Austria; September 1997] delegates at a Pierre Fabre-sponsored symposium were told that milnacipran is a novel antidepressant which could fit this therapeutic niche.