Levomilnacipran (Fetzima) is the active enantiomer of milnacipran (Ixel, Savella) for norepinephrine (NE) and serotonin (5-hydroxytryptamine, 5-HT) reuptake. It has an approximate eight-fold greater affinity for the human NE transporter than for the 5-HT transporter (Auclair et al., 2013). This signifies that the NE transporter may be engaged to a much greater degree than the 5-HT transporter at various doses, especially at lower regimens. As such, levomilnacipran represents the mirror antidepressant medication of venlafaxine and duloxetine since at their minimal effective doses, these medications are selective inhibitors of 5-HT reuptake and it is not until daily regimens are doubled or tripled that the NE transporter gets engaged (Vincent et al., 2004; Debonnel et al., 2007).