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).

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).

Many consider olanzapine to be more effective than other antipsychotics and just below clozapine in effectiveness. Its high efficacy along with its once-daily dosing and low risk of QT interval prolongation are appealing. However, olanzapine’s high risk for weight gain and metabolic complications make it a second-line choice for many. The newly approved Lybalvi combines olanzapine with samidorphan to minimize weight gain—but it’s only moderately successful. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

There are many longer-acting methylphenidate preparations. Two good options are Concerta and Ritalin LA, both of which are now available generically. 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).

Vortioxetine is a newer “multimodal” antidepressant with diverse effects on neurotransmitters. Recent data suggest that vortioxetine may have pro-cognitive effects and may be less likely to cause sexual side effects than SSRIs. It is reasonable to try the drug in patients who have complained of SSRI-induced sexual dysfunction. A high prevalence of nausea and the high brand-name price tag are negative factors to consider. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

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).

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).

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).

Ziprasidone has an appealing weight and metabolic profile, but many clinicians get scared off by its reputation for lengthening the QT interval. This risk is overblown, and it should probably be prescribed more. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).