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).

Nausea or sensation of upset stomach beginning soon after first dose of a new medication. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Vitamin D supplementation may be beneficial in depression, but reserve its use for those who have low vitamin D levels, and make sure patients take adequate doses, in the range of 1000–5000 IU daily. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Not commonly used due to side effects and overdose toxicity risk; however, TCAs should be considered for appropriate patients who do not respond to other antidepressants. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Bottom Line: Lamotrigine is a good choice for maintenance treatment of bipolar disorder, especially to prevent depressive episodes. It has a good side effect profile. Its main disadvantage is the very slow titration schedule recommended to decrease the risk of Stevens-Johnson syndrome—as well as its ineffectiveness in the treatment of manic episodes. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Passing of loose or watery stools, at least three times in a 24-hour period. Often due to infectious etiology (eg, rotovirus, norovirus, adenoviruses, E. coli) but can occur as a side effect to medications. Most cases resolve with routine over-the-counter treatment. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Haloperidol is an effective, inexpensive first-generation antipsychotic with low weight gain potential and a long history of experience and use, but clinical utility is limited due to EPS and potential for TD. It’s favored by many clinicians for treatment of acute agitation, especially when given in an IM “cocktail” with lorazepam and diphenhydramine. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Dexmethylphenidate (Focalin) is the d-isomer of methylphenidate and is two times more potent than methylphenidate. Azstarys is a newly approved (and expensive) combination of Focalin and a prodrug version of Focalin—the Focalin is absorbed quickly while the prodrug is absorbed more slowly (it’s the Vyvanse of methylphenidate). There’s no clear advantage of Focalin over Ritalin—the main difference is that Focalin may mean fewer tablets for patients. Focalin XR only recently went generic, so it will likely remain quite expensive for a while. Azstarys may be less abusable than Focalin. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Aducanumab is an antibody that attacks and dissolves the amyloid protein that is thought to contribute to Alzheimer’s dementia. It is the first new drug approved for Alzheimer’s since 2003. Unfortunately, it is marginally effective at best, requires monthly IV infusion, has cumbersome monitoring requirements, and carries potentially significant side effects, all at very high cost. Until we learn more about its efficacy and side effects, we don’t recommend it. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Excessive sweating, which tends to be more prominent in the face, neck, and chest, and less prominent in the armpits and palms. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).