Methylphenidate has a better side effect profile and somewhat lower abuse potential than amphetamines. However, patients often prefer the “kick” they get from Adderall. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Vyvanse may have a gentler, “smoother” side effect profile than other amphetamines, and it probably has a lower risk of diversion or abuse. However, its high cost even in generic form means insurance companies don’t like to pay for it without prior authorization. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Mirtazapine tends to cause weight gain and sedation, but no sexual dysfunction or GI side effects, and thus is particularly useful in depressed patients with anxiety or insomnia, those who have had sexual side effects with other antidepressants, and those who may benefit from appetite stimulation (eg, elderly, cancer patients). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Memantine’s indication (moderate to severe dementia only) may limit its use, but it does boast a unique mechanism of action and has some data to support its usefulness as an augmenter of donepezil. Many prescribers put the majority of their dementia patients on a combination of one of the cholinesterase inhibitors and memantine; we recommend adding memantine when dementia has progressed to the moderate or severe level, possibly earlier. There’s no clinical benefit to using the more expensive XR version. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Zuranolone is a novel, fast-acting neurosteroid, similar to brexanolone. Rather than intravenously, it’s given orally for patients with severe postpartum depression (PPD). This new drug provides ease of use, good tolerability, rapid action, and significant improvement in patients with PPD. We recommend using it in severe PPD when rapid response is critical. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Paliperidone is the active metabolite of risperidone. In comparison with its parent compound, paliperidone has the advantages of no drug-drug interactions, an easy transition to several long-acting injectable formulations, and a unique FDA indication for schizoaffective disorder. Disadvantages include more QT interval prolongation than risperidone, more tachycardia, possibly more EPS, and the same amount of hyperprolactinemia. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Topiramate is a reasonable off-label choice for alcohol use disorder and antipsychotic-induced weight gain. Otherwise, relegate it to the “try when out of other ideas” category. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Levomilnacipran is an enantiomer of milnacipran (Savella), which is an SNRI approved in the US for fibromyalgia and in other countries for depression. Levomilnacipran is effective for depression, but its tendency to cause nausea, need for titration, and urinary effects make it a second-line SNRI after venlafaxine or duloxetine. It is the most adrenergic of all the SNRIs, which may explain its high side effect potential. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Thioridazine prolongs the cardiac QT interval more than any other antipsychotic, rendering it too risky to use for the majority of patients. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Sleepiness as a result of medications, usually due to antidepressants. Typically, patients say they sleep more than enough at night, yet they feel like they could fall asleep at any point throughout the day. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).