Omega-3 fatty acids form the lipid bilayers of cell membranes, and supplementing our natural dietary supply may have psychological and cardiological benefits. Based on the limited data available, the best use of omega-3 fatty acids (particularly 1–2 g with at least 60% EPA) is as an adjunct in the treatment of unipolar and bipolar depression. There is not enough evidence to recommend omega-3 fatty acids in other psychiatric disorders at this time. 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).

Esketamine is the s-enantiomer of ketamine, given as a nasal spray. It is only modestly effective for treatment-resistant depression and suicidality; its main advantage is its speed of onset, which is typically 24 hours. FDA requirements mandate that it be given in a health care facility and that patients be monitored for two hours after each treatment. Most clinicians consider it less effective than the unapproved intravenous use of ketamine. 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).

Namzaric combines donepezil and memantine in a single capsule. It is helpful for patients who are already on this combination regimen but who have trouble taking two pills. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Many consider olanzapine to be more effective than other antipsychotics and just below clozapine in effectiveness. Its high efficacy along with its once-daily dosing and low risk of QT interval prolongation are appealing. However, olanzapine’s high risk for weight gain and metabolic complications make it a second-line choice for many. The newly approved Lybalvi combines olanzapine with samidorphan to minimize weight gain—but it’s only moderately successful. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

There are many longer-acting methylphenidate preparations. Two good options are Concerta and Ritalin LA, both of which are now available generically. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Like the first norepinephrine reuptake inhibitor for ADHD, atomoxetine, viloxazine has no abuse potential and is less likely than stimulants to cause insomnia, anxiety, or tics. However, it is generally less effective than stimulants and takes longer to work. It’s unclear if it has any advantage, and unlike atomoxetine, there’s no option for a cheaper generic. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Ziprasidone has an appealing weight and metabolic profile, but many clinicians get scared off by its reputation for lengthening the QT interval. This risk is overblown, and it should probably be prescribed more. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Magnesium supplementation is purported to improve symptoms of ADHD, insomnia, or anxiety, but supporting or convincing evidence is lacking, and most get the magnesium they need from their diet. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).