Vilazodone is essentially an SSRI with the addition of some buspirone-type effects. Early claims of sexual side effect advantages over other SSRIs are unproven. Disadvantages include the slow titration schedule, the need to take it with food in order to achieve a therapeutic blood level, and the many drug interactions. Until further notice, vilazodone should remain a second-line antidepressant. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

A rare but potentially life-threatening drug reaction presenting with muscle rigidity (“lead pipe”), hyperthermia, and altered mental status. May present similarly to serotonin syndrome although may be less acute in onset (within days vs hours). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Clonidine is an alpha-2 agonist that has no abuse potential, does not worsen tics, and does not cause insomnia. However, it’s less effective than stimulants and has a delayed onset of effect (two to four weeks); it is often added to a stimulant to prevent insomnia. Clonidine may be used as a second-line option for opioid detoxification if buprenorphine or methadone are not available. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Escitalopram is a good first-line SSRI option. It has the tolerability and minimal drug interaction potential of citalopram with less QT prolongation risk. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

While modafinil can be helpful for many causes of excessive sleepiness, realize that many people end up using it offlabel for lifestyle enhancement, such as working, studying, and partying. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Lurasidone offers some advantages, including no need for titration, once-daily dosing, relatively low-moderate metabolic profile, and relatively low QT prolongation risk. It is also one of five antipsychotics approved for bipolar depression (along with cariprazine, lumateperone, olanzapine/fluoxetine, and quetiapine). However, its use is limited by the need to administer with at least 350 calories of food, potential for drug interactions, and side effects including sedation, akathisia, and EPS. In clinical practice, you might lump lurasidone with the other second-generation antipsychotics that cause little weight gain, such as aripiprazole and ziprasidone. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Lavender essential oil is a reasonable option in patients who have not responded to FDA-approved treatments for generalized anxiety disorder (GAD) or in patients who request a natural alternative. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Paroxetine is the least favored SSRI due to its side effect profile (greatest sexual side effects, weight gain, sedation, constipation), drug interaction profile, and risk for discontinuation syndrome. However, its wide range of FDA anxiety indications leads some clinicians to favor it for patients with significant anxiety From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

ECT is one of the most effective treatments in psychiatry, but cognitive side effects understandably make patients reluctant to try it. We should recommend it to any patient with severe treatment-resistant depression or psychosis. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Impairment of some aspect of sexual functioning, including low libido, anorgasmia, decreased sensation, erectile dysfunction, or delayed or retrograde ejaculation (in men). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).