Cyproheptadine is sometimes effective in reversing SSRI-induced anorgasmia, but with continued use it could interfere with antidepressant efficacy. As-needed occasional use is the best strategy From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Metformin is a medication for type 2 diabetes that increases insulin sensitivity and decreases appetite. It’s somewhat effective for antipsychotic-induced weight gain (average of 3 kg weight loss) and might work better if started prophylactically as a way to prevent excessive weight gain in the first place. It’s quite safe and well tolerated (with some GI side effects) and is becoming a standard add-on treatment in patients taking clozapine or olanzapine. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Desvenlafaxine is the active metabolite of venlafaxine, and it has some minor advantages in terms of drug interactions, ease of dosing, and longer half-life. One disadvantage is lack of FDA approval for anxiety disorders. At least for depression, since desvenlafaxine is now available in a low-cost generic version, some clinicians prefer it over venlafaxine XR. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Dextroamphetamine is the dextro-isomer of racemic amphetamine. It has a long history of safe use in children, and is available in short- and long-acting formulations as generics. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Daytrana is helpful for kids who, for whatever reason, cannot use any of the wide variety of oral stimulant preparations. Otherwise, we don’t recommend it due to high cost, lag time for onset of effect, and the side effect of rash, which is pretty common and unpleasant. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Lithium is the gold standard for bipolar disorder. It is more useful for euphoric mania than for mixed and rapid-cycling types of bipolar disorder, but it is effective for depressive episodes and maintenance treatment of bipolar disorder. It is also known for its antisuicide effects in bipolar and unipolar mood disorders. It is likely underprescribed due to side effect concerns—though most patients tolerate lithium quite well. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

A sense of restlessness, causing the patient to appear fidgety, to have difficulty sitting still, and to rock from one leg to the other while standing. It can present as an inner sense of restlessness without obvious movement. Can lead to agitation and even suicidal ideation. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Adderall contains 75% dextroamphetamine and 25% levoamphetamine. This ratio of amphetamine isomers is effective but is probably the most abused and diverted of all prescription stimulants. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Fluvoxamine is used less often due to twice-daily dosing, sedation, risk for drug interactions, and fewer data for uses other than OCD, even though it’s likely just as effective as other SSRIs. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Amphetamine is a 50:50 racemic mixture of dextro- and levo-amphetamine. In clinical practice, the most commonly prescribed amphetamine is Adderall (mixed amphetamine salts; see fact sheet later in this chapter). Based on metaanalyses, amphetamines are clearly the most effective option in both children and adults with ADHD. That doesn’t mean they should always be the first choice, though. Methylphenidates are often better tolerated and have relatively less abuse potential. Several newer formulations of amphetamine may be helpful for patients who don’t like to swallow pills—but they come with a price tag. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).