Pregabalin is structurally related to gabapentin and is likely more effective for psychiatric disorders, especially generalized anxiety disorder (GAD) and social anxiety disorder. 

Atomoxetine is a nonstimulant attention-deficit/hyperactivity disorder (ADHD) treatment that carries no abuse potential, causes less insomnia and anxiety, and is unlikely to worsen tics.

Vilazodone is essentially an SSRI with added buspirone-like 5-HT1A partial agonist effects.

TCAs are less commonly used today due to side effects and overdose risk but remain a valid option for patients who haven’t responded to other antidepressants.

Trazodone is most often prescribed at low doses (25–50 mg) as a sleep aid.

Thyroid augmentation—usually with T3 (Cytomel)—is sometimes used to treat fatigue and lethargy in depression. It is inexpensive, generally well tolerated, and may help, especially when paired with tricyclic antidepressants.

Sertraline is a strong first-line selective serotonin reuptake inhibitor (SSRI) due to its broad FDA indications, flexible dosing, minimal drug interactions, and good overall tolerability.

Emsam is a transdermal monoamine oxidase inhibitor (MAOI) with fewer dietary restrictions at the 6 mg dose—and possibly even at higher doses. It tends to cause less weight gain and fewer sexual side effects than oral MAOIs.

Dr. Carlat and Dr. Puzantian have no financial relationships with companies related to this material.
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