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Main Menu: Psychiatric Medications

Psychiatric Medications

This Menu contains links to pages related to various PSYCHIATRIC MEDICATIONS. Other Main Menus can be found by hovering over the MENUS tab at the top of every page on this website.


In the Menu below, click on the category (or the arrow to the left of its name) to EXPAND the category and see what is included in it. When you are done, click on the category (or the arrow to the left of it) to COLLAPSE the category back.


Patient Education

What is the ONE website that is BEST for all your patient education needs?

FDA-approved “Medication Guides” for patients

Patient handouts: Potential side effects of psychiatric medications

Patient handouts from Simple and Practical

What are the BEST books on each topic related to psychiatry/ mental health?


ADHD medications

ADHD medications—General topics

Tips for prescribing ADHD medications

Tips for managing abuse potential of medications for ADHD

Important interactions when using two medications for ADHD

How should ADHD be treated in persons with stimulant (including cocaine) use disorder

Stimulant medications

Stimulant medications: General articles

Also see: ADHD medications—General topics

What are the closest alternatives when forced to switch a stimulant?

A dozen tips to manage loss of appetite due to a stimulant (in adults)

Converting stimulants: Equivalent doses

Pros and cons of short-acting preparations of psychostimulants

Tips for managing abuse potential of medications for ADHD

Stimulant medications and irritability in children with ADHD

Stimulants for ADHD with a history of a substance use disorder?

Don’t change the stimulant medication without first asking about this

What if you refuse an early refill of a stimulant medication?

What to look for in stimulant withdrawal (including a physical sign that is little known)

Stimulant “holidays” (breaks) in adults with ADHD?

How to get full-day coverage with stimulants

Do stimulants need to be titrated up again after an interruption?

How to re-titrate stimulant medications after an interruption

Do we need to worry about stimulant medications as our patients become older adults? 

Clinical recommendations: What to do about stimulant medications in older adults

 Can patients with ADHD develop tolerance to stimulant medications?

Can psychostimulant medications cause or worsen Raynaud’s phenomenon?

What can we do about the shortage of stimulant medications?

Laws about prescriptions for psychostimulants

Are stimulants useful after traumatic brain injury?

What to do about stimulant medications for surgery or other procedures under anesthesia

How are methylphenidate and amphetamines metabolized?

Four kinds of atypical responses to stimulant medications

Can I take my medication with me when I travel to another country?

What patients taking a stimulant medication must know before visiting Japan

Amphetamine preparations

Amphetamine preparations: Index and links

Pros and cons of dextroamphetamine versus levoamphetamine.

Eight tips for reducing the risk of  abuse/diversion of stimulants

Ketogenic diet and amphetamines

Vitamin C if on a stimulant?

Does lisdexamfetamine really have lower abuse potential? 

Converting from OROS methylphenidate to amphetamine is a two-step process

Amphetamine (Dynavel-XR®) extended-release oral suspension: Basic information

Amphetamine extended-release orally disintegrating tablets (Adzenys XR-ODT): Basic information

What is the maximum dose of mixed amphetamine salts?

Do psychostimulant medications cause clinically significant increases in blood pressure?

How exactly should blood pressure be monitored in persons on stimulants

How to manage stimulant-induced hypertension

When prescribing an amphetamine, warn patients about anti-acid medications

Dextroamphetamine (Dexedrine®): Basic Information

Lisdexamfetamine (Vyvanse®): Basic Information

Mixed amphetamine salts (Adderall®, Adderall XR®): Basic Information

Mixed salts of a single-entity amphetamine product (Mydayis®): Basic information

Triple-bead preparation of mixed amphetamine salts (Mydayis®)

Should we ever prescribe methamphetamine (Desoxyn®)?

Methylphenidate/ Dexmethylphenidate Preparations

Methylphenidate preparations

Methylphenidate/ dexmethylphenidate preparations: Index and links

How to choose between generic, long-acting methylphenidate/ dexmethylphenidate preparations

OROS methylphenidate extended-release (Concerta®): Basic information

Converting from OROS methylphenidate to amphetamine is a two-step process

Methylphenidate (Ritalin, Ritalin SR®, Ritalin LA®): Basic information

A psychostimulant preparation that is taken in the *evening* (Jornay PM®)


Dexmethylphenidate preparations

Methylphenidate/ dexmethylphenidate preparations: Index and links

How to choose between generic, long-acting methylphenidate/ dexmethylphenidate preparations

Should we prescribe dexmethylphenidate (Focalin) rather than methylphenidate (Ritalin)?

Dexmethylphenidate (Focalin®, Focalin XR®): Basic Information

Does serdexmethylphenidate+dexmethylphenidate (Azstarys®) have significant advantages?

Combining stimulants with other medications

Combine a stimulant and atomoxetine?

Going from atomoxetine to an antipsychotic

Combining guanfacine and stimulants for ADHD

Can stimulant and antipsychotic medications be used together?

Changing from an antipsychotic to a stimulant

When a stimulant and an antipsychotic are used together and then the stimulant is stopped

Can a dopamine agonist (pramipexole, ropinirole) and a stimulant be combined?

 Can stimulant medications be used along with buprenorphine or methadone?

Norepinephrine reuptake inhibitors

Atomoxetine

Atomoxetine (Strattera®): Basic Information

Don’t ignore atomoxetine for ADHD in adults

Order genetic testing for a patient on atomoxetine?

Seizure risk if atomoxetine and bupropion are used together?

Combine a stimulant and atomoxetine?

It makes a big difference—atomoxetine once a day or twice a day?

What can we do for somnolence/ sedation on atomoxetine?


Viloxazine extended-release (Qelbree®)

Viloxazine extended-release capsules (Qelbree®): Basic information

Alpha-2 agonists

Clonidine

Clonidine (Kapvay®) extended-release tablets: Basic Information

Guanfacine versus clonidine for ADHD

Guanfacine

Guanfacine extended-release (Intuniv®): Basic Information

Does guanfacine work for ADHD in adults?

Should we combine methylphenidate and guanfacine? 

Guanfacine versus clonidine for ADHD

How to manage stimulant-induced hypertension

Other medications for ADHD

Do you prescribe bupropion for ADHD in adults?

Does modafinil work for ADHD?


Agitation medications

Dexmedetomidine (Igalmi™): Basic information

Should we use droperidol, which is available again?


Anti-Addiction medications

Acamprosate

Acamprosate (Campral®): Basic Information

Tips on using acamprosate for alcohol use disorder

Benzodiazepines for alcohol withdrawal

Which benzodiazepines for alcohol withdrawal syndrome (AWS)?

Benzodiazepine regimens for preventing or treating alcohol withdrawal

Buprenorphine

Buprenorphine (Subutex® and Suboxone®): Basic Information

Clinical pearls on prescribing buprenorphine (Suboxone®)

Clinical pearls about prescribing buprenorphine: Part Two

Disulfiram

Disulfiram—Why and How

How to use disulfiram to help with alcoholism

Disulfiram: A shortcut to sobriety?

Tips on offering disulfiram for alcohol use disorder


Disulfiram—Avoiding “hidden” sources of alcohol

Principles to help patients starting on disulfiram avoid hidden sources of alcohol

Specific tips to give to patients about how to avoid “hidden” alcohol in food and beverages

What are “non-alcoholic,” “alcohol-free,” “low alcohol,” and “reduced alcohol” beverages?

Where to find/ buy non-alcoholic or alcohol-free beer

Non-alcoholic or alcohol-free beer in patients with past alcohol use disorder?

Do we need to specifically tell persons with alcoholism to avoid drinking kombucha?

Recommend these alcohol-free mouthwash options to patients on disulfiram or with a dry mouth

Patients on disulfiram may appreciate being told about these alcohol-free options for fragrances


Disulfiram—Side Effects

How common is liver toxicity with disulfiram, and when does it occur?

When and how often should hepatic function tests be done in patients on disulfiram?

Naloxone

Special issues in using naloxone for overdoses involving fentanyl

YouTube video on how to use Evzio®

Naltrexone

Naltrexone (Revia®, Vivitrol®): Basic Information

Tips on using naltrexone for alcohol use disorder

How high can we go with naltrexone for alcohol use disorder?

What if a patient on naltrexone is in acute pain?

Does naltrexone cause insomnia OR does it cause sleepiness?


Naltrexone extended-release injectable (Vivitrol®)

Naltrexone (Revia®, Vivitrol®): Basic Information

Tips on using naltrexone extended-release injectable (Vivitrol®)

Could extended-release naltrexone injection work for alcohol use disorder even if oral naltrexone did not?

How to order, store, and administer naltrexone extended-release injection (Vivitrol®)

Find a Vivitrol® prescriber


Low-dose naltrexone (LDN)

What is low-dose naltrexone (LDN) and should it be used for anything?

Nicotine replacement therapy

A practical guide to nicotine replacement therapy (NRT)

How exactly should nicotine patches be used?

How exactly should nicotine gum be used?

How exactly should nicotine lozenges be used?

How exactly should nicotine oral inhalers be used?

How exactly should nicotine nasal spray be used?

Thiamine (for prevention of Wernicke-Korsakoff syndrome)

How exactly to prescribe thiamine for the prevention of Wernicke-Korsakoff syndrome

Varenicline

Varenicline (Chantix®): Basic Information

Are varenicline (Chantix) and bupropion safe for smoking cessation in persons with mental disorders?

A practical guide to using varenicline (Chantix®) for tobacco (smoking) cessation

Other

How to learn addiction psychiatry

A practical guide to the management of tobacco use disorder

Do electronic cigarettes (e-cigarettes) work for smoking cessation?

What “authorities” say about e-cigarettes for tobacco use disorder 

What are electronic cigarettes (e-cigarettes)?

Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)

Bupropion for cocaine use disorder?

APA Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

Should we consider gabapentin for alcohol use disorder?


Antiamyloid antibodies

Antiamyloid antibodies—General articles

New, “disease-modifying” treatments for Alzheimer’s disease

Why amyloid-β and amyloid plaques are so important


Antiamyloid antibodies—Lecanemab

Untangling exactly whom lecanemab (Leqembi®) is FDA-approved for

How well does lecanemab (Leqembi®) work?

Should we recommend treatment with lecanemab (Leqembi®)?

Lecanemab (Leqembi®) carries an important boxed warning


Antiamyloid antibodies—Donanemab

A brief review of donanemab (Kisunla®) for Alzheimer’s disease


Antianxiety medications

Also see: “Benzodiazepines” (below)

Beta-blockers

Clinical tips on using a beta-blocker for performance anxiety (“stage fright”)

Beta-blockers for panic disorder?

What are the different types of beta-blockers?

Can beta-blockers cause depression or is this a myth?

CNS side effects of beta-blockers

Beta-blockers can either worsen or improve erectile dysfunction

Which beta-blockers in persons with diabetes?

Are beta-blockers contraindicated in asthma?


Buspirone

Can buspirone cause dyskinesia or parkinsonism?

Serotonin syndrome with a combination of buspirone and a serotonergic antidepressant?

Can buspirone cause increased prolactin or galactorrhea?

Buspirone (Buspar®): Basic Information


Complementary and Alternative Medicine (CAM) for Anxiety

L-theanine for anxiety or stress?


Gabapentin

Gabapentin (Neurontin®) for anxiety disorders?

Gabapentin (Neurontin®): Basic Information

Potential side effects of gabapentin (Neurontin® (handout)

Gabapentin (Neurontin®) or pregabalin (Lyrica®) abuse, dependence, and withdrawal

Is it important to taper gabapentin?

How to change from gabapentin (Neurontin®) to pregabalin (Lyrica®)


Hydroxyzine

Hydroxyzine (generic, Vistaril®): Basic Information

How are hydroxyzine pamoate (Vistaril®) and hydroxyzine hydrochloride (Atarax®) different?

Does hydroxyzine have advantages over diphenhydramine?

Do we need to avoid hydroxyzine in older adults?

Hydroxyzine (Vistaril®, Atarax®) is associated with an increased risk of QT prolongation

QT prolongation with hydroxyzine versus diphenhydramine

Potential side effects handout of hydroxyzine (Vistaril®)

Which psychiatric medications should be stopped before skin prick allergy testing?


Pregabalin

Pregabalin (Lyrica®): Basic information

Potential side effects handout for pregabalin (Lyrica®)

Pregabalin (Lyrica®): Pharmacological effects

Does pregabalin (Lyrica®) work for generalized anxiety disorder (GAD)?

Pregabalin (Lyrica®) for generalized anxiety disorder (GAD) with partial response to a serotonergic antidepressant?

What dose of pregabalin (Lyrica®) should we use for generalized anxiety disorder (GAD)? 

How to change from gabapentin (Neurontin®) to pregabalin (Lyrica®)

Gabapentin (Neurontin®) or pregabalin (Lyrica®) abuse, dependence, and withdrawal


Serotonin reuptake inhibitors

Should we give high-dose SSRIs for panic disorder?

Does vortioxetine work for Generalized Anxiety Disorder (GAD)?


Other

Would you ever use bupropion to treat panic disorder?


Anticholinergic medications

Should we routinely prescribe an anticholinergic with an antipsychotic?

Important differences between anticholinergic medications

For how long should anticholinergics be given for antipsychotic-induced parkinsonism?

After a few months, try to reduce/ stop anticholinergic medication

How does toxicity from anticholinergic medications present clinically?

Cholinergic rebound syndrome: Why we should NOT stop anticholinergic medications abruptly

An anticholinergic medication for antidepressant discontinuation (withdrawal)?

Topical anticholinergics for localized hyperhidrosis


Antidepressant medications

General topics about antidepressants

Antidepressant medications: Dose equivalents

Which antidepressants are FDA-approved for use in pediatric patients?

Antidepressants are like antibiotics

Can we increase the levels of all THREE neurotransmitters in major depression?

How and when to titrate up antidepressants

Do any antidepressants come in liquid forms?

Antidepressants: What are the alternatives to the oral route?

Sometimes, a medication may be given rectally

Different and confusing ways in which antidepressants are classified

Pharmacological effects of antidepressants explain the alternative names for their classification

S-adenosylmethionine (SAMe) for depressive disorders: An overview

Which antidepressants are better than the SSRIs?

How to titrate antidepressants: which medications, which patients, how much, how long

Antidepressants: how much and for how long?

Combining antidepressants: Are two better than one?

SSRI/ SNRI plus mirtazapine: What three clinical trials found

Factors to consider in switching from one antidepressant to another

Switching antidepressants: Lessons from a difficult case

Can patients have alcohol while on an antidepressant?

Omega-3 fatty acids for depressive disorders?

Complementary and alternative medicines (CAM) for depressive disorders

Do antidepressants work and which ones work better? (Interview with Michael Thase, MD)

Adjunctive estrogen for perimenopausal depression?

Antidepressants in the Medically Ill

Antidepressants to use and to avoid in persons with comorbid medical illness

Antidepressants to use and to avoid in patients with cardiac disease

Antidepressants to use and to avoid in patients with renal (kidney) disease

Antidepressants to use and to avoid in patients with liver disease

Antidepressants and risk of stroke

Is mirtazapine safe to use after a renal transplant?

N-methyl-D-aspartate (NMDA) receptor antagonists

Esketamine nasal spray (Spravato®)

Esketamine nasal spray (brand name Spravato): Basic information

What does “treatment-resistant depression” in the indication for esketamine (Spravato®) mean?

How well does esketamine nasal spray (Spravato®) work for treatment-resistant depression?

Common and other side effects of esketamine nasal spray (Spravato®) 

Dissociation and perceptual disturbances with esketamine nasal spray (Spravato®)

Esketamine nasal spray (Spravato®): Clinical trials in “treatment-resistant depression”

Stimulants in a patient receiving ketamine/ esketamine?

What about concomitant medications during ketamine or esketamine treatment?


Ketamine (off-label)

Ketamine for major depression: An overview

How can response to intravenous ketamine be maintained?

Common myths about IV ketamine for depressive disorders

Stimulants in a patient receiving ketamine/ esketamine?

What to do about concomitant medications during ketamine or esketamine treatment


Oral ketamine (off-label)

Should we consider ORAL ketamine for clinical depression/ suicidality?


Dextromethorphan and bupropion (Auvelity™)

Dextromethorphan and bupropion (Auvelity™): Basic Information

Why is dextromethorphan combined with a CYP 2D6 inhibitor?

Dextromethorphan-bupropion (Auvelity™): Efficacy

Understanding antidepressant clinical trial results: Dextromethorphan-bupropion (Auvelity™)

Potential side effects of dextromethorphan and bupropion (Auvelity™)

Does dextromethorphan-bupropion (Auvelity™) have abuse potential?

A primer on dextromethorphan abuse or dependence

Can generic dextromethorphan and bupropion be used instead of the brand name combination?

Dextromethorphan: pharmacodynamics (receptor effects)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Citalopram

Citalopram (Celexa®): Basic Information

Escitalopram

Escitalopram (Lexapro®): Basic Information

Fluoxetine

Fluoxetine (Prozac®): Basic Information

Fluvoxamine

Is fluvoxamine more effective for OCD than other SSRIs?

What to do about excessive sweating in this patient with OCD

Fluvoxamine (Luvox®): Basic Information

Paroxetine

Why I don’t usually prescribe paroxetine

Paroxetine (Paxil® or Paxil CR®): Basic Information

Sertraline

Is sertraline safe in lactation?

Sertraline (Zoloft®): Basic Information

Miscellaneous

Who is at higher risk of bleeding with antidepressants?

Antidepressants and bleeding: When and what to ask?

Should we give high-dose SSRI for panic disorder?

Serotonin syndrome with a combination of buspirone and a serotonergic antidepressant?

Do stimulant medications work for major depressive disorder?

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

General

Are there clinically-important differences between the various SNRIs?

SNRIs differ in the extent of norepinephrine reuptake inhibition

Desvenlafaxine

Reasons to prefer desvenlafaxine (Pristiq®) over venlafaxine (Effexor XR®)

How exactly should desvenlafaxine be stopped?

Duloxetine

Antidepressant discontinuation (withdrawal): Duloxetine

How can duloxetine can be tapered very slowly?

Pros and cons of venlafaxine versus duloxetine

Duloxetine (Cymbalta®): Basic Information

Levomilnacipran

Levomilnacipran (Fetzima®): Basic Information

Levomilnacipran (Fetzima®): Efficacy

Levomilnacipran (Fetzima®): Pharmacological Effects

Levomilnacipran (Fetzima®): Pharmacokinetics

Levomilnacipran (Fetzima®): Drug Interactions

Levomilnacipran (Fetzima®): Adverse Effects

Levomilnacipran (Fetzima®): An organized list of references

Venlafaxine

When a patient has difficulty getting off venlafaxine

Reasons to prefer desvenlafaxine (Pristiq®) over venlafaxine (Effexor XR®)

Pros and cons of venlafaxine versus duloxetine

Which causes more weight gain—venlafaxine or duloxetine?

Venlafaxine (Effexor XR®): Basic Information

Venlafaxine (Effexor XR®) versus SSRIs

Other second-generation antidepressants

Bupropion

Bupropion (Wellbutrin SR® or Wellbutrin XL®): Basic Information

Bupropion Preparations (Wellbutrin XL® and others)

Bupropion (Wellbutrin XL®) versus SSRIs

Why isn’t bupropion the most frequently prescribed antidepressant?

Can we increase levels of all THREE neurotransmitters in major depression?

Is generic bupropion as effective as brand-name Wellbutrin®?

What factors can increase the risk of seizures with bupropion?

Bupropion and seizures: the facts and the myths

Is a history of seizures in early childhood a contraindication to using bupropion?

Bupropion in persons with renal impairment

Would you ever use bupropion to treat panic disorder?

Seizure risk if atomoxetine and bupropion are used together?

Does bupropion treat antidepressant-induced sexual dysfunction?

Are varenicline (Chantix) and bupropion safe for smoking cessation in persons with mental disorders?

Can patients on bupropion drink alcohol? Part one

Bupropion for cocaine use disorder?

How and why is bupropion sometimes used to “get high”?

Mirtazapine

Mirtazapine (Remeron®): Basic Information

Is mirtazapine LESS sedating at higher doses?

Can mirtazapine be started at 30 mg per day?

Is mirtazapine safe to use after a renal transplant?

Is mirtazapine (Remeron) better than SSRIs for the treatment of major depressive disorder?

Combining antidepressants: Are two better than one?

Three RCTs of SSRI/ SNRI plus mirtazapine from the start

Is it true that mirtazapine (Remeron®) can cause agranulocytosis?

Mirtazapine may cause akathisia at higher doses

Can mirtazapine increase the risk of QT prolongation?

Trazodone

Trazodone (Desyrel®): Basic Information

Trazodone and priaprism

Vilazodone

Vilazodone (Viibryd®): Basic Information

Vilazodone (Viibryd®): Efficacy

Vilazodone (Viibryd®): Pharmacological Effects

Vilazodone (Viibryd®): Drug Interactions

Vilazodone (Viibryd®): Adverse Effects

Podcast: 14 Key questions about vilazodone (Viibryd®)

Vortioxetine

Vortioxetine (Trintellix®): Basic Information

Vortioxetine (Trintellix®): Efficacy

Does vortioxetine work for Generalized Anxiety Disorder (GAD)?

Vortioxetine versus other antidepressants

Vortioxetine (Trintellix®): Pharmacological effects

What side effects can occur with vortioxetine (Trintellix®)?

Potential side effects handout for vortioxetine (Trintellix®)

PsychopharMYTH: “Vortioxetine does not cause sexual dysfunction”

Vortioxetine (Trintellix®): Drug Interactions

Brand name change for Brintellix® (vortioxetine)

Vortioxetine (Trintellix®): An organized list of references

Tricyclic/tetracyclic antidepressants

Tricyclic/tetracyclic antidepressants—General articles

Tricyclic/Tetracyclic Antidepressants (TCAs): An overview

How to choose a tricyclic antidepressant

Which TCA do I usually recommend first?

Which tricyclic antidepressants (TCAs) are the most effective ones for major depressive disorder (MDD)?

Many patients are on low-dose TCAs. Can other antidepressants be added?

TCAs other than clomipramine for OCD?


Tricyclic/tetracyclic antidepressants—Tertiary amines

How is imipramine palmoate (Tofranil-PM) different from imipramine hydrochloride (Tofranil)?

Clomipramine versus SSRIs for OCD

When and how to check the clomipramine level

How to interpret clomipramine and desmethylclomipramine levels

Doxepin and cytochrome P450 drug interactions

Are doxepin’s anticholinergic effects dose-dependent?

Doxepin (Sinequan®): Basic Information


Tricyclic/tetracyclic antidepressants—Secondary amines

How to order and interpret the serum nortriptyline level

Nortriptyline (Pamelor®): Basic Information

Monoamine Oxidase Inhibitors (MAOIs)

Classic MAO inhibitors

Classic MAO inhibitors—General

Types of MAO and of MAO inhibitors

Are MAO inhibitors (MAOIs) efficacious and safe for bipolar depression?

Combining an MAO inhibitor and another antidepressant

Can antidepressants be used with MAO-B inhibitors?

How to manage major depressive disorder with atypical features

Phenelzine

Phenelzine (Nardil®): Basic Information

How to choose between phenelzine (Nardil®) and tranylcypromine (Parnate®)

Selegiline

Selegiline Transdermal System (Emsam®): Basic Information

Tranylcypromine

Tranylcypromine (Parnate®): Basic Information

How to choose between phenelzine (Nardil®) and tranylcypromine (Parnate®)

Isocarboxazid

Isocarboxazid (Marplan®): Basic Information

MAO inhibitors—Diet

MAO inhibitor diet

MAO Inhibitor diet (patient handout)

Can I have cheese or pizza?

How about some Chinese food?

MAO inhibitors and goat cheese

MAO inhibitors—Side effects

How to choose between phenelzine (Nardil®) and tranylcypromine (Parnate®)

MAO inhibitor-induced insomnia

MAO inhibitors and edema

MAO inhibitors can affect vitamin B6 (pyridoxine)

Rash, irritation, or itching with transdermal patches

MAO inhibitors—Drug interactions

MAO inhibitors and other medications

MAO Inhibitors and other medications (patient handout) (link to the handouts page)

Be very careful when switching from one MAO inhibitor to another

MAO inhibitors (MAOIs) and contraindicated medications: How long do we have to wait?

How to switch from oral or transdermal selegiline (Emsam®) to another MAO inhibitor

Should we prescribe emergency medication for hypertensive urgency with MAO inhibitors?

Pramipexole

Pramipexole for major depressive disorder or bipolar depression

Tips on using pramipexole for mood disorders

Pramipexole: Basic information

Potential adverse effects of pramipexole

Can a dopamine agonist (pramipexole, ropinirole) and a stimulant be combined?

Dopamine agonist withdrawal syndrome (DAWS)

Antidepressants—Side effects

Three SSRIs that may cause QT prolongation

Antidepressant-induced tardive dyskinesia

Which antidepressants in patients with a history of, or at higher risk for, bleeding

Antidepressants can injure the liver, some more than others

How common is new-onset hyponatremia during antidepressant treatment?

Tinnitus associated with antidepressant medications

Also see: MAO Inhibitors—Side effects

Antidepressants—Drug interactions

Some antidepressants may have clinically important interactions with tramadol (Ultram(R))

Direct-acting oral anticoagulants (DOACs) and antidepressants


Antipsychotic medications

General

Antibiotics, antipsychotics, and QTc prolongation

Which antipsychotics to prefer in patients with catatonia

Antipsychotics and QTc prolongation

How often should we order ECG (EKG) during treatment with a psychotropic medication?

Avoid these three antipsychotics in women with breast cancer

The patient who “demands” TWO antipsychotics

Practice guideline: Antipsychotics for agitation/psychosis in dementia

Second-generation (atypical) antipsychotics

General

Second-generation (“atypical”) antipsychotics (List)

Second-generation antipsychotics: Dose equivalents

Dose adjustment for second-generation antipsychotics based on drug interactions

Do adolescents have more metabolic side effects with second-generation antipsychotics?

Does weight gain with second-generation (atypical) antipsychotics plateau after the first few months?

Do adolescents have more metabolic side effects with second-generation antipsychotics?

What should I be doing to monitor patients who are on an antipsychotic?

The patient who “demands” TWO antipsychotics

Aripiprazole (Abilify®)

FDA issues new warning about aripiprazole (impulse control problems)

How exactly to add aripiprazole for hyperprolactinemia with risperidone

What dose of aripiprazole as an adjunct for OCD?

Resolution of hyperglycemia after switching to aripiprazole

Can aripiprazole *worsen* psychosis?

Aripiprazole (Abilify®): Basic Information

Aripiprazole with sensor (Abilify Mycite®): Basic Information


Aripiprazole—Long-acting injectable (LAI) preparations

Aripiprazole (Abilify Maintena®): Basic Information

Aripiprazole lauroxil (Aristada®): Basic Information

Aripiprazole lauroxil (Aristada Initio™): Basic information

Aripiprazole extended-release injectable suspension (Abilify Asimtufii®): Basic Information 

Aripiprazole lauroxil (Aristada®) versus Aripiprazole (Abilify Maintena®)

How to convert from oral to long-acting injectable (LAI) aripiprazole

Be careful in converting from Abilify Maintena® to Aristada®

Why does Abilify Maintena® have an FDA indication for bipolar disorder but Aristada® does not?

Asenapine (Saphris®)

Asenapine (Saphris®): Basic Information

Brexpiprazole (Rexulti®)

Brexpiprazole (Rexulti®): Basic Information

Potential side effects of brexpiprazole (Rexulti®)

Cariprazine (Vraylar®)

Cariprazine (Vraylar®): Basic Information

Cariprazine (Vraylar): Potential side effects

Activity of cariprazine (Vraylar®) on dopamine D3 and D2 receptors

Cariprazine (Vraylar®): Organized list of references

Clozapine (Clozaril®)

Clozapine—General information

Clozapine (Clozaril®): Basic Information

Why we must refer more patients for clozapine treatment

What can we do about the underutilization of clozapine and delays in starting it?

Where can I find someone who prescribes clozapine?

Clozapine for schizophrenia in children?

Changes in rules about clozapine

Clozapine—Serum level

How to check and interpret clozapine levels

Are the clozapine-norclozapine ratio and norclozapine level useful?

Can oral contraceptives affect clozapine levels?

Caffeine can significantly change serum clozapine levels

Clozapine—Side effects

Potential side effects of clozapine (Clozaril®) handout

Key information about seizures with clozapine

Clozapine-induced hypersalivation (sialorrhea)

Clozapine-induced hypersalivation (sialorrhea): Treatment

Management of clozapine-induced constipation

Benign ethnic neutropenia (BEN)

Iloperidone (Fanapt®)

Iloperidone (Fanapt®): Basic Information

Lumateperone (Caplyta®)

Lumateperone (Caplyta®): Basic information

Is lumateperone (Caplyta®) really different from other atypical antipsychotics?

How well does lumateperone (Caplyta) work for schizophrenia?

A summary of the potential side effects of lumateperone (Caplyta®)

Potential side effects of lumateperone (Caplyta®) handout

Is lumateperone less likely to cause extrapyramidal symptoms (including parkinsonism or akathisia)?

Can lumateperone (Caplyta®) cause metabolic side effects?

Lurasidone (Latuda®)

Lurasidone (Latuda®): Basic Information

Lurasidone (Latuda®): Pharmacological Effects

Lurasidone (Latuda®): Efficacy

Lurasidone (Latuda®): Drug Interactions

Lurasidone (Latuda®): Adverse Effects

What are the possible risks of using lurasidone (Latuda®) during pregnancy

Which psychiatric medications MUST be taken with food?

Does lurasidone (Latuda®) really have a low risk of increasing serum prolactin?

Olanzapine (Zyprexa®)

Olanzapine (Zyprexa®): Basic Information

Does olanzapine (Zyprexa®) really have a low risk of increasing serum prolactin?


Olanzapine—Long-acting injectable (LAI) preparation

Olanzapine (Zyprexa Relprevv®): Basic Information

Extended-Release Olanzapine (Zyprexa Relprevv®): REMS


Olanzapine-Samidorphan (Lybalvi®)

Olanzapine and samidorphan (Lybalvi®): Basic information

Samidorphan versus naltrexone: What’s the difference?

How much better is olanzapine-samidorphan (Lybalvi®) than olanzapine alone? Part 1

Paliperidone (Invega®)

Paliperidone (Invega®): Basic Information

Potential side effects of paliperidone (Invega®): Patient handout


Paliperidone—Long-acting injectable (LAI) preparations

Paliperidone palmitate (Invega Sustenna®): Basic Information

Paliperidone palmitate 3-month (Invega Trinza®): Basic Information

Paliperidone palmitate 6-month (Invega Hayfera™): Basic Information

Pimavanserin (Nuplazid®)

Pimavanserin (Nuplazid): Basic Information

What is pimavanserin (Nuplazid®)?

Pimavanserin (Nuplazid®): Potential adverse effects

Quetiapine (Seroquel®)

Quetiapine (Seroquel®, Seroquel XR®): Basic Information

Which psychotropic medications should be taken WITHOUT food?

The dose of quetiapine is NOT the same for each disorder

Is quetiapine (Seroquel®) a reasonable option for treating insomnia?

Why it matters that quetiapine’s metabolite is a *norepinephrine* reuptake inhibitor

Risperidone (Risperdal®)

Risperidone (Risperdal®): Basic Information

News: July 6, 2016. Make sure you are discussing the increased risk of gynecomastia with risperidone

How exactly to add aripiprazole for hyperprolactinemia with risperidone


Risperidone—Long-acting injectable (LAI) preparations

Equivalence of risperidone oral and long-acting injection (RLAI; Risperdal Consta®)

Ziprasidone (Geodon®)

Ziprasidone (Geodon®): Basic Information

Antipsychotics and QTc prolongation

When to do an electrocardiogram (ECG or EKG)?

Cardiovascular risk screening form

Does ziprasidone (Geodon®) really have a low risk of increasing serum prolactin?

Long-acting injectable (LAI) antipsychotics: General articles

 

(For our articles about long-acting injectable preparations of specific antipsychotics, please look under that antipsychotic on this page.)

Long-acting injectable antipsychotics: Overview

Dose equivalents of long-acting injectable second-generation antipsychotics

How *NOT* to offer long-acting injectable (LAI) antipsychotics to patients

Which injections can only be given in the gluteal muscle—and why?

How to choose between injecting into the deltoid or gluteal muscles

CPT billing code for administration of injections

When is it appropriate to combine two antipsychotics?

First-generation (typical) antipsychotics

Haloperidol (Haldol®): Basic Information

Haloperidol (Haldol® Decanoate): Basic Information

Antipsychotics—Side effects

Amantadine for antipsychotic-induced parkinsonism

Amantadine (Symmetrel): Basic Information

Is TD less likely with second-generation (“atypical”) antipsychotics?

Does any atypical antipsychotic have a lower risk of tardive dyskinesia?

Management of tardive dyskinesia: First-line options

Management of tardive dyskinesia: Second-line options

How long does antipsychotic-induced hyperglycemia take to resolve?

Resolution of hyperglycemia after switching to aripiprazole

Be careful if a person is on both a stimulant and an antipsychotic

What could happen when changing from an antipsychotic to a stimulant?

Key information about seizures with clozapine

Can we use topiramate to treat medication-induced weight gain?

Potential risks of second-generation (atypical) antipsychotics in pregnancy

Akathisia: Treatment with a beta-blocker

Antipsychotics—Drug interactions

Smoking and psychotropic medications

Alpha-2 adrenergic receptor agonists

Dexmedetomidine (Igalmi™): Basic information

Off-label treatments for schizophrenia and related psychotic disorders

Cannabidiol for schizophrenia or other psychotic disorders? An overview

What did randomized, double-blind clinical trials of cannabidiol in schizophrenia find?

Does estrogen have a role in schizophrenia?

Estrogen as a treatment for schizophrenia?


Benzodiazepines

Benzodiazepines—General articles

Three important pieces of information about benzodiazepines

Practical tips on using hypnotics: benzodiazepines

Viewpoint: Has the pendulum swung too far against the use of benzodiazepines?

Cytochrome P450 drug interactions with benzodiazepines

Benzodiazepines in the elderly and in liver disease

Should we consider a benzodiazepine for persons with major depressive disorder?

Alprazolam

Alprazolam (Xanax® or Xanax-XR®): Basic Information

Potential side effects of alprazolam (Xanax®)

How to convert from alprazolam immediate-release to extended-release

Potential advantages and disadvantages of alprazolam extended-release (Xanax XR®)

Chlordiazepoxide

Chlordiazepoxide (Librium®): Basic Information

Clonazepam

Clonazepam (Klonopin®): Basic Information

Potential side effects of clonazepam (Klonopin®)

Tips on using clonazepam ODT (wafers)

Diazepam

Diazepam (Valium®): Basic Information

Lorazepam

Lorazepam (Ativan®): Basic Information

Potential side effects of lorazepam (Ativan®)

Oxazepam

Oxazepam (Serax®): Basic Information

Temazepam

Temazepam (Restoril®): Basic Information

Benzodiazepines for alcohol withdrawal

Which benzodiazepines for alcohol withdrawal syndrome (AWS)?

Benzodiazepine regimens for preventing or treating alcohol withdrawal

Benzodiazepine use disorder

Getting off a benzodiazepine: What should the rate of taper be?

How to find a detoxification (detox) center


Beta-blockers

Clinical tips on using a beta-blocker for performance anxiety (“stage fright”)

Beta-blockers for panic disorder?

Akathisia: Treatment with a beta-blocker

Beta-blockers for lithium-induced benign tremor

What are the different types of beta-blockers?

Can beta-blockers cause depression or is this a myth?

CNS side effects of beta-blockers

Beta-blockers can either worsen or improve erectile dysfunction

Which beta-blockers in persons with diabetes?

Are beta-blockers contraindicated in asthma?


Bibliotherapy

Bibliotherapy: Recommend books to your patients and their families

BEST Books on Depressive disorders: for patients and families

BEST books on how to change habits

BEST books about how to lose weight

An Unquiet Mind

BEST books on Alzheimer’s disease and other dementias

BEST books on Adult Asperger’s Syndrome

Best books on adult ADHD: For patients and families

Book review: Mindfulness prescription for Adult ADHD

Book review: ADHD-Friendly Ways to Organize Your Life

Best book for choosing a rehab


  Cholinesterase Inhibitors—see Cognitive Enhancers


Cognitive Enhancers

Cholinesterase Inhibitors

Alzheimer’s disease: Medications

How to choose a cholinesterase inhibitor

Switch cholinesterase inhibitors?

Medications for dementia: Alternative preparations

Donepezil (Aricept®, Aricept ODT®): Basic Information

Galantamine (Razadyne, Razadyne ER): Basic Information

Rivastigmine (Exelon®, Exelon® Patch): Basic Information

Memantine

Memantine (Namenda®, Namenda XR®): Basic Information


Digital therapeutics

What is NightWare and should we recommend it to persons with nightmares?


Dopamine Agonists

Dopamine agonists—General articles

Can a dopamine agonist (pramipexole, ropinirole) and a stimulant be combined?

Dopamine agonist withdrawal syndrome (DAWS)

Pramipexole

Pramipexole: Basic information

Pramipexole for major depressive disorder or bipolar depression

Tips on using pramipexole for mood disorders

Potential adverse effects of pramipexole

Can a dopamine agonist (pramipexole, ropinirole) and a stimulant be combined?

Important! Dopamine agonist withdrawal syndrome (DAWS)

Ropinirole

Can a dopamine agonist (pramipexole, ropinirole) and a stimulant be combined?

Ropinirole (Requip®, Requip XL®) for major (unipolar) depression or bipolar depression?

Important! Dopamine agonist withdrawal syndrome (DAWS)


GABA-A positive modulators

Zuranolone (Zurzuvae™): Key facts

Brexanolone (brand name Zulresso®): Key facts


Hypnotics

Hypnotics—General Articles

FDA-approved medications for the treatment of insomnia (hypnotics)

Non-addictive sleep medications

Is quetiapine (Seroquel®) a reasonable option for treating insomnia?

Best hypnotics in elderly patients?

Hypnotics to avoid in the elderly (older adults)

Which hypnotics to use or avoid in persons with sleep apnea


Benzodiazepines

Practical tips on using hypnotics: Benzodiazepines

Temazepam (Restoril®): Basic Information


Doxepin

Doxepin (Silenor®): Basic Information


Melatonin receptor agonists

Melatonin

Does melatonin work for insomnia?

Low-dose preparations of melatonin

Which brand and preparation of melatonin to recommend

Melatonin agonists for preventing and treating delirium?

What are the potential side effects of melatonin?

Does melatonin need to be gradually tapered off when stopping it?

Can melatonin have negative effects on puberty?  

Can melatonin increase blood sugar?

What drug interactions can occur with melatonin? 


Ramelteon

Pros and cons of ramelteon (Rozerem®) as a hypnotic

Ramelteon (Rozerem®): Basic Information


Orexin receptor antagonists

What is the orexin system, and why is it so important?

An overview of dual orexin receptor antagonists (DORAs)

Potential side effects of dual orexin receptor antagonists (DORAs)

Do dual orexin receptor antagonists (DORAs) have a low risk of abuse or dependence?

Are dual orexin receptor antagonists (DORAs) safe in obstructive sleep apnea? 

Daridorexant (Quviviq®): Basic information

Lemborexant (Dayvigo®): Basic information

Suvorexant (Belsomra®): Basic information


Z-drugs

Practical tips on using hypnotics: the Z drugs

How to match the patient with the right Z-drug

Give all these instructions while prescribing zolpidem

Are the Z-drugs (zolpidem and others) safe to take during pregnancy?

Hypnotic if waking up in the middle of the night?

Eszopiclone (Lunesta®): Basic Information

Zolpidem (Ambien® and Ambien CR®): Basic Information

Zaleplon (Sonata®): Basic Information


Non-Medication Interventions for Insomnia

Sleep masks for better sleep

Blue-light-blocking glasses

Sleep Hygiene Worksheets

Sleep log: Ten important questions about the person’s sleep


Ketogenic diet and psychotropic medications

Ketogenic diet and amphetamines

Ketogenic diet and topiramate

Ketogenic diet and valproate


L-methylfolate, folate, and related compounds

L-methylfolate, folate, and related compounds: Evaluation

Serum folate is not the right test to order


L-methylfolate, folate, and related compounds: Therapeutic use

What you need to know about L-methylfolate (Deplin®)

Four forms of folate

Folate, folic acid, and methylfolate: Multiple choice questions

A simple way to significantly reduce the cost of l-methylfolate (Deplin®)

L-methylfolate (Deplin®): Basic information

Which l-methylfolate preparations should we recommend?


L-methylfolate, folate, and related compounds: Side effects

Folic acid may counteract the benefit of lamotrigine 

L-methylfolate can sometimes precipitate irritability, agitation, insomnia, or aggressiveness

Does folate/ L-methylfolate supplementation DECREASE or INCREASE the risk of breast cancer?


Medications for treating feeding and eating disorders

Lisdexamfetamine (Vyvanse®) for binge-eating disorder


Medications for treating obsessive-compulsive and related disorders

SSRIs for OCD

Higher than usual doses of SSRIs for OCD?

SSRIs for OCD: How high can we go?

Clomipramine versus SSRIs for OCD

Add clomipramine to an SSRI for OCD?

Concerns about combining clomipramine and SSRIs

How exactly to add clomipramine to an SSRI

When and how to check the clomipramine level

How to interpret clomipramine and desmethylclomipramine levels

OCD: Second-line medications

Antipsychotic “augmentation” for OCD

Is fluvoxamine more effective for OCD than other SSRIs?

N-acetylcysteine (NAC) for obsessive-compulsive disorder (OCD)?

Poor man’s vortioxetine

Body Dysmorphic Disorder: Pharmacological treatment

How to use serotonin reuptake inhibitors to treat body dysmorphic disorder

How to treat excoriation (skin picking) disorder: Pharmacological treatment


Medications for treating sexual dysfunction

General

Beta-blockers can worsen or improve erectile dysfunction

Cyproheptadine (Periactin®) for antidepressant-induced sexual dysfunction (ADISD)?

Which antidepressant for the treatment of premature ejaculation?

Treatment of premature ejaculation with antidepressants—daily or as-needed?

Flibanserin

Flibanserin (Addyi®)

Flibanserin (Addyi®) in postmenopausal women

Flibanserin (Addyi®): Basic information

Flibanserin (Addyi®): Systematic list of references

Phosphodiesterase-5 inhibitors (PDE-5 inhibitors)

Which PDE-5 inhibitor for erectile dysfunction?


Medications for treating trauma and stress-related disorders

Does prazosin work for PTSD? If so, for which symptoms?

How exactly should we dose prazosin in PTSD?

Warning! Prazosin can lead to hypotension/ syncope after the first dose

PTSD-associated nightmares: Menu of treatment options

Are psychostimulant medications contraindicated in persons with PTSD?


Melatonin receptor agonists

Melatonin

Melatonin: An introduction

Does melatonin work for insomnia?

What are the potential side effects of melatonin?

Can melatonin have negative effects on puberty?

Can melatonin increase blood sugar?

Low-dose preparations of melatonin

Which brand and preparation of melatonin to recommend

Ramelteon

Pros and cons of ramelteon (Rozerem) as a hypnotic

Ramelteon (Rozerem®): Basic Information

Miscellaneous

Melatonin agonists for preventing and treating delirium?

Melatonin agonists for sundowning in major neurocognitive disorder (dementia)?


Mood Stabilizers

Mood stabilizers—General articles

How many days to wait before measuring the blood level of any medication

When to measure serum levels of mood stabilizers

Combination therapy (mood stabilizer plus antipsychotic) for acute mania?

A practical guide to the management of bipolar disorders with mixed features

Does gabapentin work for bipolar disorder?

 Encourage pregnant women on an antiepileptic drug to enroll in these registries

Carbamazepine and Oxcarbazepine

Carbamazepine

Carbamazepine (Equetro®, Tegretol®-XR): Basic Information

Carbamazepine for neuropsychiatric symptoms in persons with dementia?

How should carbamazepine be discontinued?

What to do about contraception in women on carbamazepine or oxcarbazepine

HLA antigens and psychotropic drugs


Oxcarbazepine

Does oxcarbazepine (Trileptal®) work?

Advantages and Disadvantages of Trileptal® (oxcarbazepine) versus Tegretol® (carbamazepine)

How to start, titrate, and dose oxcarbazepine (Trileptal®)

Oxcarbazepine (Trileptal®): Plasma levels

What to do about contraception in women on carbamazepine or oxcarbazepine

Divalproex (or valproate or valproic acid)

How to prescribe divalproex

Also see: Mood stabilizers—General articles

Divalproex (Depakote®, Depakote ER®): Basic Information

Divalproex (Depakote®) or valproic acid (Depakene®) preparations

Divalproex (valproate) loading dose

What lab tests should we do in patients on divalproex (Depakote)?

All about when and how to order a FREE valproic acid level?

What is the optimal serum valproic acid (valproate) level?

Ketogenic diet and valproate

How to add valproate to lamotrigine

Efficacy of divalproex for different conditions

Does divalproex (valproate) work for bipolar depression?

Valproate for neuropsychiatric symptoms in dementia?

Side effects of divalproex

Valproate and hair loss (alopecia)

Valproate-induced pancreatitis

False-positive elevation of plasma ammonia

Valproate (Depakote®) and elevated serum ammonia level (hyperammonemia)

L-carnitine (levocarnitine; Carnitor®): Basic information

What to do if a patient develops thrombocytopenia during treatment with valproate 

Drug interactions of divalproex

Think twice before adding topiramate to valproate

Lamotrigine

Lamotrigine—General articles

Lamotrigine (Lamictal®): Basic Information

Can lamotrigine monotherapy be used for maintenance treatment in bipolar I disorder?

Lamotrigine: No additional benefit at 400 mg per day?

Why don’t we routinely prescribe lamotrigine extended-release (Lamictal XR®)?

How to add valproate to lamotrigine

Tips on using lamotrigine for mood disorders: Interview with Dr. Nassir Ghaemi


Lamotrigine—How to start

How to start and titrate lamotrigine (Lamictal®)

Dermatological precautions when starting lamotrigine


Lamotrigine—How to restart

Restarting lamotrigine

If lamotrigine is missed for a few days

Restarting lamotrigine: how many days?

Restarting lamotrigine: A case study


Lamotrigine—Skin rash

Dermatological precautions when starting lamotrigine

Is it a benign or dangerous skin rash?

How common are benign and serious rashes with lamotrigine?

Lamotrigine rechallenge after a skin rash?


Lamotrigine—Side effects (other than skin rash)

Can lamotrigine levels predict adverse effects? 

What to do about the risk of arrhythmias with lamotrigine

Can lamotrigine cause psychiatric side effects?

Can lamotrigine cause bruising?

Is the use of lamotrigine during pregnancy safe?

Oral sores in a patient on lamotrigine 


Lamotrigine—Drug interactions

5 Action Items about OCs and lamotrigine

Does lamotrigine decrease the effectiveness of oral contraceptives?

How to reduce lamotrigine when an inducer is stopped

Folic acid may counteract the benefit of lamotrigine

Lithium

Lithium: Therapeutic use

Also see: Mood stabilizers—General articles

How to know who will respond better to lithium

Lithium: In how many doses per day?

“Simple and Practical” patient education about lithium

Is the extended-release preparation of lithium carbonate better?

Should we prescribe low-dose lithium?

Lithium augmentation in major depressive disorder: How much?

Lithium augmentation in major depressive disorder: How long

Let’s not stop lithium abruptly or rapidly

If serum lithium levels vary unexpectedly, consider these possible causes

How to manage lithium treatment before and after bariatric surgery

When and how to prescribe lithium citrate oral solution

What should we tell patients who ask about lithium orotate?


Lithium: Side effects and their management

Lithium toxicity

Clinical tips for identifying lithium toxicity clinically


Lithium: Hyperparathyroidism

Lithium induced hyperparathyroidism

How to screen for lithium-induced hyperparathyroidism

Lithium-induced hyperparathyroidism: Management

How to calculate corrected serum calcium

Sensipar® (cinacalcet) Prescribing Information


Lithium: Hypothyroidism

An introduction to lithium-induced hypothyroidism

How common is lithium-induced hypothyroidism?

What are the risk factors for lithium-induced hypothyroidism?

How should lithium-induced hypothyroidism be evaluated?

How should lithium-induced hypothyroidism be managed?


Lithium: Renal impairment

Lithium-induced renal impairment: Clinical recommendations

Case: Rising serum creatinine in a patient on lithium

Case: Elevated serum creatinine that remained stable for many years

Is the extended-release preparation of lithium carbonate better?

Which preparation of lithium is less likely to harm the kidneys?

Lithium-induced polyuria and diabetes insipidus

Lithium-induced polyuria and diabetes insipidus: Evaluation

Lithium-induced polyuria and diabetes insipidus: Treatment

24-hour urine for creatinine clearance

How to collect a 24-hour urine sample


Lithium: Skin/ hair-related side effects

All about lithium-induced hair loss

Acne is a potential side effect of lithium

Lithium and psoriasis


Lithium: Tremors

Lithium-induced benign tremor: Introduction

Lithium-induced benign tremor: Evaluation

Lithium-induced benign tremor: Treatment

Beta-blockers for lithium-induced benign tremor

Vitamin B6 for lithium-induced benign tremor?


Lithium: Miscellaneous

Lithium’s effects on the electrocardiogram (ECG, EKG)

Tips on using lithium for bipolar disorder during pregnancy


Lithium: Drug interactions

Lithium and antihypertensives: Be careful!

Topiramate

Warning! Topiramate can cause kidney stones

Ketogenic diet and topiramate

Can we use topiramate to treat medication-induced weight gain?

Think twice before adding topiramate to valproate


Muscarinic agonist

Xanomeline+Trospium (Cobenfy™)

The rationale for xanomeline+trospium (Cobenfy™), approved for the treatment of schizophrenia

Efficacy of xanomeline+trospium (Cobenfy™) and comparison with second-generation antipsychotics

Xanomeline+trospium (Cobenfy™): Side effects


Psychedelics

Considerable beneficial effects are reported by psilocybin users

What side effects can psilocybin have?

Can psilocybin lead to suicide or other self-harm?

Is psilocybin addictive?

Can psychedelics cause serotonin toxicity (syndrome)?

Can a psychedelic be taken along with lithium?

What we need to know about hallucinogen persisting perception disorder (HPPD)


Thyroid hormones

Thyroid hormones for psychopharmacologists: What’s what 

Pros and cons of liothyronine (T3) and levothyroxine (T4)

Levothyroxine (T4) for augmentation of antidepressants? 

Thyroid hormone for adjunctive treatment (augmentation) with an SSRI?

Liothyronine (T3) adjunctive treatment: How much and for how long?


Vesicular monoamine transporter 2 (VMAT2) Inhibitors

Deutetrabenazine

Deutetrabenazine (Austedo®): Basic Information

Valbenazine

Valbenazine (Ingrezza®) and VMAT2

Valbenazine (Ingrezza®): Basic information

General

VMAT2 inhibitor? What’s that?

Comparing the VMAT2 inhibitors


Vitamins and Minerals

Multivitamin/ multimineral

Do’s and don’ts for taking a multivitamin

Biotin

When to consider recommending biotin supplementation

Biotin can interfere with many laboratory tests—and lead to serious misdiagnosis

Iron

Instructions for WHEN and HOW to take iron supplements

Which foods are rich in iron?

How to maximize absorption of iron supplements 

Laboratory testing to identify iron deficiency

What is the best single test for checking the body’s iron stores?

How to order and interpret iron studies

Are we missing iron deficiency without anemia?

Let’s ask about heavy menstrual bleeding

How to improve the tolerability of iron supplementation

Iron deficiency, pica, and restless legs syndrome associated with blood donation

Restless Legs Syndrome (RLS) and iron deficiency

Magnesium

Basic facts about magnesium for mental health clinicians

Magnesium supplement for suspected alcohol/ medication-induced deficiency?

Which type of magnesium supplement to recommend

Vitamin B12

How to evaluate a person’s vitamin B12 status 

Vitamin B12 and mental health 

Testing for B vitamins in persons with cognitive impairment

A patient with a low vitamin B12 level

Which supplements to recommend with a vegetarian or vegan diet

Elevated vitamin B12 levels are common and could be very serious

Vitamin D

What is vitamin D?

How should vitamin D status be measured?

How should we define vitamin D insufficiency (deficiency)?

How should vitamin D insufficiency or deficiency be treated?

Does vitamin D supplementation increase the risk of kidney stones?

Can vitamin D treat clinical depression?

Vitamin E

Vitamin E: A primer for clinicians

Does vitamin E work for tardive dyskinesia?

Vitamin E: Potential adverse effects and drug interactions

Vitamins and Minerals—Other Articles

Which vitamin supplements should we be cautious about recommending?

Kosher medications, vitamins, and supplements: Specific products

Also see: L-methylfolate, folate, and related compounds


Wakefulness-promoting agents

Armodafinil

Do modafinil/ armodafinil need cardiovascular monitoring

Armodafinil (Nuvigil®): Basic Information

Modafinil

Modafinil for ADHD?

Modafinil as an adjunct for major depressive disorder?

Do modafinil/ armodafinil need cardiovascular monitoring

Modafinil (Provigil®): Basic Information

Solriamfetol

Solriamfetol (Sunosi®): Basic Information


Weight-loss medications and treatments

Overview

Medications for weight loss?

An overview of medications for the treatment of obesity


Naltrexone and bupropion

A generic alternative to naltrexone/bupropion (Contrave®)?

Bupropion plus naltrexone (Contrave): Basic information


Metformin

Metformin to prevent or treat metabolic adverse effects due to antipsychotics

Who is more likely to benefit from metformin for the management of metabolic adverse effects?

Metformin for antipsychotic-induced weight gain in children and adolescents?

Potential adverse effects of metformin

Tips on prescribing metformin

Metformin AND topiramate for metabolic adverse effects?

Metformin for weight gain or obesity unrelated to antipsychotic medications?


GLP-1 receptor agonists

A simple primer on what GLP-1 agonists are

Semaglutide injection (Wegovy®) for weight loss in obesity and overweight

 Does tirzepatide (Zepbound®) produce *even more* weight loss than semaglutide (Wegovy®)?

Will patients regain weight after GLP-1 receptor agonists are stopped?

GLP-1 receptor agonists in patients on antipsychotic medications?

GLP-1 receptor agonists may reduce alcohol craving/ use

GLP-1 receptor agonists for binge eating?


Semaglutide injection (Wegovy®): Side effects

Tips for reducing or managing nausea/ vomiting associated with GLP-1 agonists

Could the GLP-1 receptor agonist be causing your patient’s insomnia?

Semaglutide injection (Wegovy®): Serious side effects, warnings, and contraindications

Are GLP-1 receptor agonists associated with an increased risk of suicidal ideation/ behavior?

GLP-1 receptor agonists may worsen eating disorders or precipitate disordered eating


Semaglutide injection (Wegovy®): Basic information

Tirzepatide (Zepbound®): Basic information 

Liraglutide (Victoza®, Saxenda®)


Orlistat

Orlistat (Xenical®): Basic Information


Phentermine and topiramate

Phentermine and topiramate extended-release (Qsymia®): Basic Information


Bariatric surgery

What to do about psychotropic medications after bariatric surgery

How to manage lithium treatment before and after bariatric surgery

Is bupropion sustained-release OK to use after bariatric surgery?

Why and how to monitor and evaluate for suicide risk after bariatric surgery

Why, who, and how to monitor for increased alcohol use after bariatric surgery


Treatments: Cost of medications, Pharmacies, and Prescription Drug Plans

How to find out the price of medications, compare prices, and get the lowest possible price

Tips on reducing the cost of medications by using higher-strength pills

Should we encourage patients to use independent pharmacies?

What is the procedure for obtaining an early medication refill?

Medication prices on Costco.com versus on Goodrx.com

 Should we recommend Costplusdrugs.com for lowering the cost of medications?

A simple way to significantly reduce the cost of l-methylfolate (Deplin®)

Prior authorization for medications

Pharmacy benefit managers


Canadian pharmacies?

Medications from Canadian pharmacies?

Using a Canadian pharmacy can reduce the cost of some medications


Formulations of medications

Formulations of medications—General articles

Abbreviations for controlled-release formulations are out of control!

Antidepressants: What are the alternatives to the oral route?


Formulations of medications—Capsules

Do sustained-release preparations have fewer adverse effects?

Extended-release preparations of psychotropic medications

Can extended-release capsules be opened?

When a patient has difficulty getting off venlafaxine

How can duloxetine be tapered very slowly?

Two patients where opening medication capsules was helpful


Formulations of medications—Tablets

Are bupropion SR and bupropion ER the same thing?

Why, when, and how to split medication tablets

Recommended pill cutters and pill crushers

Which tablets are actually extended-release formulations and so should not be cut?

What if patients report seeing intact pills in their stools?

Orally disintegrating tablets (ODTs) can be useful

Psychotropic medications are sometimes given sublingually


Formulations of medications—Liquids

Which antidepressants come in liquid forms?


Inactive Ingredients (Excipients) in Medications

Gluten in medications

Can lactose in medication pills cause intolerance?

How to find out whether a medication contains ingredients of animal origin


Generic medications

Are generic medications really equivalent to brand-name medications?

Generic and “authorized generic” medications

Which manufacturers of generic versions of psychotropic medications are better or worse?

Which generics of Concerta® (methylphenidate extended-release) to recommend

Is generic bupropion as effective as brand-name Wellbutrin®?

Can generic dextromethorphan and bupropion be used instead of the brand name combination?

A generic alternative to naltrexone/bupropion (Contrave®)?


Laws and Regulations About Medications

Laws about prescriptions for psychostimulants

Can I take my medication with me when I travel to another country?

What patients taking a stimulant medication must know before visiting Japan


Off-Label Prescribing

We prescribe “off-label” more often than we think

Important! Off-label prescribing is of many different types

Off-label prescribing: Clinical recommendations


Pharmacodynamics and Pharmacokinetics

Which medications are mostly excreted unchanged, and why is this important?

Some medications have a low “therapeutic index”. What exactly is that?

Psychiatric medications with a long half-life

ABCB1 polymorphisms and psychotropic medications

Why is dextromethorphan combined with a CYP 2D6 inhibitor?

What does the Ki (inhibition constant) for a drug mean?

A simple guide to serotonin receptors

Dopamine receptors: A primer for clinicians

Melanocortin 4 receptor (MC4R) and weight gain


Psychopharmacology in Special Populations

Agitation

Dexmedetomidine (Igalmi™): Basic information


Bariatric surgery

What to do about medications after bariatric surgery

How to manage lithium treatment before and after bariatric surgery

Is bupropion sustained-release OK to use after bariatric surgery?

Why and how to monitor and evaluate for suicide risk after bariatric surgery

Why, who, and how to monitor for increased alcohol use after bariatric surgery


Pregnancy and lactation

Five websites for information regarding psychotropic medications and pregnancy

Lactation and psychotropic medications: Resources

Pregnancy registries for women who become pregnant while on a psychotropic medication

Is lamotrigine use during pregnancy safe?

Tips on using lithium during pregnancy

Are the Z-drugs (zolpidem and others) safe to take during pregnancy?

Are you about to prescribe a medication that could lead to an unwanted pregnancy?


Surgery and anesthesia

What to do about psychotropic medications during elective major surgery

Can patients who are NPO not take medications orally?

Demystified: Potentially very serious interactions between MAO inhibitors (MAOI) and opioid analgesics

What to do about stimulant medications for surgery or other procedures under anesthesia


Other

Are psychiatric medications safe AFTER laser iridotomy for narrow-angle glaucoma?


Interaction of Medications with Food

Which psychiatric medications MUST be taken with food?

For medications that must be taken “with food,” how recent does the eating have to be?

Which psychotropic medications should be taken WITHOUT food?

Medications to be taken consistently, either with or without food

Do’s and don’ts regarding mixing medication with food or beverages


Miscellaneous articles

What to do about old prescriptions

Short answers to questions from our Members

Can persons on psychotropic medications donate blood?

What do the es-, the levo-, and the dex- mean in drug names?

Your patient may be taking a psychiatric medication by another brand name

How to find basic information about medications on this website

The BEST app for medication reminders/medication management

Tips for writing prescriptions: for how long, how many refills?

Is e-prescribing worth it?

Prescription Drug Monitoring Programs (PDMPs)

Where to look up information on drug shortages

Flibanserin (Addyi®)

Milnacipran (Savella®): Basic Information


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Disclaimer: The material on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other laypersons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified healthcare professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.

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Comments

  1. Shira Rubinstein says

    November 6, 2023 at 9:12 pm

    What articles do you have on treatments for perimenopausal mood and vasomotor symptoms?
    Specifically I am looking for article on SSRIs and SNRIs and other non-hormonal options.
    Many thanks

    • Rajnish Mago, MD says

      November 12, 2023 at 5:27 pm

      I went to our Main Menu for “Disorders/ Conditions” and, in that Menu, to the category of “Women’s mental health”. It showed that we have the following two articles about perimenopausal symptoms and their treatment:

      Tips on managing perimenopausal symptoms

      Adjunctive estrogen for perimenopausal depression?

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