Propranolol has several uses in psychiatry, including performance anxiety, drug-induced tremor, and akathisia.

Prazosin is an alpha-1 antagonist (FDA approved for hypertension) that has become popular as a treatment for insomnia/nightmares associated with post-traumatic stress disorder (PTSD). 

NAC is a glutamate modulator derived from the amino acid cysteine. It’s been tested in many psychiatric conditions, but shows the most promise as an adjunctive treatment to selective serotonin reuptake inhibitors for compulsive behaviors like obsessive-compulsive disorder (OCD), trichotillomania, nail biting, and skin picking.

When a benzodiazepine is appropriate for use (short term; minimal risk of abuse), we consider lorazepam to be a first-line agent.

Lavender essential oil (Silexan) is a well-tolerated, over-the-counter option for mild to moderate generalized anxiety disorder (GAD), supported by studies showing effect sizes comparable to standard treatments.

Gabapentin used to be considered a nonaddictive medication for anxiety and for alcohol dependence, but we now know it may be misused and diverted for its euphoriant effect.

Flurazepam is an older benzodiazepine that has fallen out of favor due to its very long half-life and its active metabolites.

Diazepam has a long history of use with good efficacy for anxiety. Its long half-life makes it a particularly effective anxiolytic for some patients, and it is a good alternative to chlordiazepoxide for alcohol withdrawal.

Diazepam has a long history of use with good efficacy for anxiety. Its long half-life makes it a particularly effective anxiolytic for some patients, and it is a good alternative to chlordiazepoxide for alcohol withdrawal.

Dexmedetomidine is an alpha-2 agonist (think clonidine) that is used at higher doses intravenously (IV) (as Precedex) for ICU sedation.