Pregabalin is structurally related to gabapentin and is likely more effective for psychiatric disorders, especially generalized anxiety disorder and social anxiety disorder. It can also be helpful for patients struggling to discontinue benzodiazepines. Now that the generic is available, it’s no longer more expensive than gabapentin and preferable in most cases. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Antihistamines can be very effective sleep aids for many patients, although some patients may experience too much grogginess (“hangover”) in the morning. They are good first-line agents due to a low risk of drug tolerance, dependence, or abuse, but exercise caution in the elderly, who are more sensitive to cognitive and peripheral effects. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

An uncomfortable sensation of dryness due to diminished saliva; can lead to dental caries, because saliva has an antibacterial effect. Can also cause decreased taste and inflammation of gums. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

May be particularly useful for individuals whose depression is associated with fatigue and poor concentration. Absence of sexual side effects and weight gain make this an appealing option for many depressed patients. Although not effective for anxiety disorders, it is effective for the anxiety that often accompanies depression. The seizure risk is not a concern for most patients when dosed appropriately From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Melatonin is secreted by the pineal gland, and its rise in serum levels correlates with the time course of natural sleep. Short-term melatonin treatment appears to only modestly reduce the time it takes to fall asleep (about 12 minutes, which might not be considered clinically relevant) and does not appear to significantly improve overall sleep time. However, some patients report minor improvement in subjective feelings of sleep quality. It is cheaper than the melatonin agonist ramelteon (Rozerem); however, like ramelteon, it lacks good long-term safety data, especially with regard to effects on hormones. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Tried and true, risperidone’s moderate side effect profile has led to its wide use, and many clinicians consider it their antipsychotic of choice for first-episode psychotic disorders. Just be cautious when dosing higher than 4 mg daily, since akathisia and other side effects are more common. Hyperprolactinemia is fairly common, so be vigilant for symptoms such as lowered libido, amenorrhea, gynecomastia, and galactorrhea. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Emsam is an MAOI patch with less likelihood of dietary interactions at 6 mg, and possibly at higher doses too. Probably fewer side effects than other MAOIs, such as weight gain and sexual side effects, and other potential advantages, including better compliance among patients who do not like swallowing pills and less suicide risk (it’s harder to overdose on a patch than with pills). When MAOIs are indicated, this may be the least risky option to try From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Tetrabenazine was the original VMAT inhibitor brought to market and approved for the treatment of Huntington’s disease. It’s an off-label alternative to deutetrabenazine and valbenazine for treating tardive dyskinesia (TD). Although it’s much less expensive, it requires more frequent dosing and may have a higher likelihood of causing depression. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

May provide faster onset of response and may be helpful in treatment-resistant patients; however, the evidence is too limited to endorse these preliminary findings. Risk of misuse and very high cost further limit its use. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Some research indicates that curcumin, the active ingredient in turmeric, may have benefits for cognitive health, depression, and anxiety. While it’s generally safe, its bioavailability is a significant issue, and more research is needed. It could be considered for patients with mild to moderate symptoms who prefer natural treatments. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).