MAOIs are not commonly used due to side effects, dietary restrictions, and drug interactions; however, they should be considered for appropriate patients who do not tolerate or respond to other antidepressants. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Flurazepam is an older benzodiazepine that has fallen out of favor due to its very long half-life and its active metabolites. It is not our first choice of benzodiazepines for insomnia; we prefer temazepam or lorazepam instead. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Oxcarbazepine, an analog of carbamazepine, is popular because of its reputation as a kinder, gentler carbamazepine, which it’s gained due to its more favorable side effect and drug interaction profile. However, due to the paucity of efficacy data in bipolar disorder, it is reserved for second-line use after lithium and valproic acid, and even after carbamazepine. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Galantamine has no appreciable benefit over donepezil; however, its availability in a liquid formulation is helpful for patients who have difficulty swallowing pills. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Ketamine is an intravenous (IV) agent that appears uniquely effective for patients who need an ultra-rapid antidepressant, such as patients who are acutely suicidal. Its disadvantages are that it is not FDA approved for depression, and that it requires close medical monitoring during administration. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Orthostatic hypotension (OH) is caused by blood pooling in the lower extremities when people stand up, causing less blood flow to the brain and consequent dizziness. Usually caused by medications that block the alpha-1 receptors, which are responsible for telling the body to constrict blood vessels (and maintain blood pressure) after standing up. Patients will report feeling faint when they get up, and occasionally a sense of the room spinning (vertigo). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Hydroxyzine is an antihistamine that is a good non-addictive option when your patient needs a rapid-acting anxiolytic. But beware of its anticholinergic effects, especially in patients who take many doses throughout the day From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Pitolisant is the only non-DEA-scheduled treatment option approved for patients with narcolepsy, but limited experience and data, plus a higher price tag, make it a second-line option after the “vigil” drugs. However, for patients with both cataplexy and excessive daytime sleepiness (EDS), it may be a better option than Xyrem, Lumryz, or Xywav. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Trazodone is most commonly used as a hypnotic at low doses (25–50 mg), but at higher doses it is effective for depression, and it has the advantage of fewer sexual side effects and less weight gain compared to other serotonergic antidepressants. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Venlafaxine is probably somewhat more effective than SSRIs for depression, but its side effect disadvantages, such as blood pressure elevation and discontinuation symptoms, relegate it to second-line use. Venlafaxine’s active metabolite, desvenlafaxine, may be preferred by some over the parent compound—see our desvenlafaxine fact sheet in this chapter. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).