Methamphetamine is highly addictive when used in its crystal form (“crystal meth”), because it causes an immediate and intense high when snorted or smoked. Its use is generally not recommended. Watch the television show “Breaking Bad” if you’re not convinced! From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Ambien is the original Z-drug, having been initially FDA approved in 1992. It is a good hypnotic that can also help with sleep maintenance, particularly in the ER formulation. The lower-dose sublingual version (Intermezzo) has a shorter duration of action and can be taken in the middle of the night—but we recommend using cheaper generic zaleplon instead for middle-of-the-night awakening. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Vortioxetine is a newer “multimodal” antidepressant with diverse effects on neurotransmitters. Recent data suggest that vortioxetine may have pro-cognitive effects and may be less likely to cause sexual side effects than SSRIs. It is reasonable to try the drug in patients who have complained of SSRI-induced sexual dysfunction. A high prevalence of nausea and the high brand-name price tag are negative factors to consider. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Vitamin D supplementation may be beneficial in depression, but reserve its use for those who have low vitamin D levels, and make sure patients take adequate doses, in the range of 1000–5000 IU daily. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Passing of loose or watery stools, at least three times in a 24-hour period. Often due to infectious etiology (eg, rotovirus, norovirus, adenoviruses, E. coli) but can occur as a side effect to medications. Most cases resolve with routine over-the-counter treatment. 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).

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).

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).

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).

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).