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).

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).

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).

Vardenafil doesn’t offer any benefits compared to sildenafil, which has more data in the psychiatric setting and more clinical experience. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Dexmedetomidine is an alpha-2 agonist (think clonidine) that is used at higher doses intravenously (as Precedex) for ICU sedation. This new lower-dose sublingual formulation is approved for acute agitation associated with schizophrenia and bipolar disorder. However, its high cost, absence of data beyond 24 hours, potential adverse effects, and need for patient cooperation for sublingual administration limit its utility. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Doxepin may be a good agent to put in your arsenal, particularly for those patients in whom you want to avoid benzodiazepines or Z-drugs. Now that the low-dose (3 and 6 mg) generic version of Silenor is available, price is less of a limitation. 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).

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).

Rapid regular movements of body parts, especially hands. Classified as fine vs coarse, and as resting vs postural vs intention. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).