NAC is a glutamate modulator and is derived from the amino acid cysteine. It has been tested for many psychiatric conditions, but is most likely effective as an add-on treatment to SSRIs in OCD, trichotillomania, nail biting, and skin picking. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Equetro is the only FDA-approved formulation of carbamazepine for bipolar disorder, but use of other formulations would result in the same effects at a lower price. Generally, carbamazepine is not considered a first-line treatment for bipolar disorder due to its side effect profile and high likelihood of significant drug interactions. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Nefazodone was once popular due to the lack of sexual side effects, but is now rarely used due to rare hepatic effects. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Atomoxetine is a non-stimulant ADHD treatment that carries no abuse potential, causes less insomnia and anxiety, and is unlikely to worsen tics. Unfortunately, it is generally less effective than stimulants and takes longer to work (two to four weeks). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Daridorexant is the third agent in the class of orexin receptor antagonists. Like the other agents in its class, it is no more effective than benzos or Z-drugs, and it has a similar abuse liability. We’re concerned that next-day impairment is a potential side effect at the higher dose, particularly since sleepless patients may decide on their own to take even higher doses. It’s not a first-line hypnotic. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Alprazolam is fast acting and effective for generalized anxiety disorder (GAD) and panic disorder, but its short duration of action may contribute to breakthrough symptoms between doses and make withdrawal more difficult. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Flibanserin, marketed as the “pink Viagra,” is mildly effective for enhancing sexual desire, but with potentially significant side effects and precautions regarding alcohol use around the time of administration. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Iloperidone is not recommended as a first-choice agent due to twice-daily dosing, need for titration, QT prolongation (comparable to ziprasidone), dizziness, moderate weight gain, and increases in blood sugar; and because it appears less efficacious than other antipsychotics. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Chlorpromazine was the first antipsychotic to be developed. Its long track record and good sedative properties make it popular for certain populations, especially patients with chronic psychosis, agitation, and mania, particularly when they are hospitalized. Its availability as an IM injection is an advantage for treating acute agitation. As a low-potency agent, it is less likely to cause EPS than many other antipsychotics. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

 Involuntary contractions of muscles due to some antipsychotics. Can include torticollis (twisting neck), opisthotonos (arching spine or neck), oculogyric crisis (eyes rolling back), and trismus (jaw clenching). Rare but serious is tongue swelling, which can block the airway or cause choking when eating. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).