Gabapentin used to be considered a non-addictive medication for anxiety and for alcohol dependence, but we now know it may be misused and diverted for its euphoriant effect. If monitored closely, it can still be helpful for anxiety and insomnia, especially if your patient also suffers from one of the approved indications—such as neuropathic pain and restless legs syndrome. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Loxapine is being rediscovered as a well-tolerated first-generation antipsychotic—it is of medium potency, and causes minimal EPS or weight gain. An oldy-but-goody alternative to second-generation antipsychotics. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Amantadine is a dopaminergic medication used primarily in Parkinson’s disease, but it is also helpful in drug-induced parkinsonism and has fewer anticholinergic side effects (eg, cognitive impairment, dry mouth, constipation) than other meds used to combat extrapyramidal symptoms (EPS), like benztropine. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Buspirone is a reasonable option in anxious patients for whom benzodiazepines are not appropriate. Don’t expect as robust a response, and make sure patients know it may take a week or two to kick in. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Deutetrabenazine was the second of the VMAT inhibitors to be approved for the treatment of tardive dyskinesia (TD) in 2017. Its advantage over off-label tetrabenazine is less frequent dosing and less likelihood of causing depression. However, it is extremely expensive—about $7,000/month as opposed to $700/month for tetrabenazine. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Fluoxetine’s wide spectrum of indications and its long track record make it a go-to SSRI, and it is often favored in patients who could use some activation. Its main disadvantage is its high potential for drug interactions. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

L-tryptophan is an amino acid that is eventually converted to serotonin. The evidence base to support using L-tryptophan in depression is extremely limited, but more and more patients are turning to it, especially in combination “serotonin boost” products being marketed today. We recommend sticking to the serotonergic agents we know to be safe and effective: SSRIs and SNRIs. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Donepezil is the cholinesterase inhibitor with the longest track record and with which we have the most experience. It is generally considered the first-line agent for dementia. Though not a cure, it delays dementia progression by six to 12 months. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Thyroid augmentation is often chosen for patients with depression-associated lethargy and fatigue. The usual formulation used is T3 (Cytomel). Response rates in clinical trials are mixed and only modest, but thyroid augmentation is inexpensive and well tolerated and may be worth a try, especially for patients on tricyclics (the evidence is less impressive for SSRI augmentation). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

When a benzodiazepine is appropriate for use (short-term; minimal risk of abuse), we consider lorazepam to be a firstline agent. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).