Lumateperone is the newest second-generation antipsychotic, approved to treat adults with schizophrenia or bipolar disorder. It appears to have a good tolerability profile and the convenience of once-daily dosing and no titration. But for now, cost relegates it to second-line use. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Sildenafil is the original PDE-5 inhibitor, and as such it has the best evidence and longest track record. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Typically, patients will report food craving and binging. Weight gain is rapid in the first three months, more gradual over the following year, then often plateaus. Rapid initial weight gain is correlated with greater eventual cumulative weight gain. FDA definition of weight gain is ≥7% increase in weight from baseline. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

L-methylfolate is a metabolite of dietary folic acid, and is necessary for the synthesis of the main neurotransmitters relevant to psychiatric disorders. Though the data are not robust, folate supplementation might be effective for some patients with depression, but we recommend that patients try the cheap stuff (folic acid) before springing for Deplin (L-methylfolate). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

A very limited number of studies have shown promise for saffron in ADHD, depression, and anxiety. It’s likely safe to use, so you may consider it for patients with milder symptoms or who are reluctant to take medications. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Lemborexant was the second orexin receptor antagonist to win FDA approval. It is no more effective than benzos or Z-drugs, and it has a similar abuse liability. We’re concerned that next-day impairment is a potential side effect at the highest approved dose of 10 mg, particularly since sleepless patients may decide on their own to take even higher doses. It’s not a first-line hypnotic. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Thiothixene is one of the original high-potency first-generation antipsychotics—but most clinicians would opt for fluphenazine or haloperidol because of their greater familiarity and range of formulation options (eg, liquid, injectable, long-acting). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

The oxybates are often used by sleep specialists as first-line agents for narcolepsy with cataplexy. It’s unlikely that many psychiatrists will prescribe them, given the side effect profile and potential for misuse. Pitolisant, which is easier to use and is not a controlled substance, may be a better option for most patients with both cataplexy and excessive daytime sedation (EDS) associated with narcolepsy. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Lecanemab, like aducanumab, is an antibody that attacks and dissolves the amyloid protein that is thought to contribute to Alzheimer’s dementia. It is the first monoclonal agent to receive traditional approval from the FDA. Although the trial data with this agent are more rigorous and positive, it is still marginally effective at best, requires twice-monthly IV infusion, has cumbersome monitoring requirements, and carries potentially significant side effects, all at very high cost. We can’t recommend it until we see more positive data. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

TMS is a reasonable option for patients who have failed several antidepressant trials and who are willing to commit to daily clinic visits for up to six weeks. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).