Also known as pseudoparkinsonism, these drug-induced symptoms mimic those of Parkinson’s disease: ⦁ Tremor (especially apparent in the hands as a resting, “pill rolling” tremor). ⦁ Rigidity (cog-wheel rigidity). ⦁ Bradykinesia (slow movement), decreased arm swing. ⦁ Shuffling gait. ⦁ Slurred speech. ⦁ Mask-like facies, stooped posture, drooling. ⦁ Psychological side effects, such as cognitive dulling (bradyphrenia), worse negative symptoms (neuroleptic-induced deficit syndrome), worse depression (neuroleptic dysphoria). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Diazepam has a long history of use with good efficacy for anxiety. Its long half-life makes it a particularly effective anxiolytic for some patients, and it is a good alternative to chlordiazepoxide for alcohol withdrawal. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Molindone is an effective, well-tolerated first-generation antipsychotic of medium potency—a solid medication that some clinicians have gained experience with and favor for select patients. Recently it has been reintroduced into the market, and is still generic and inexpensive. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Dopamine agonists are effective first-line agents for restless legs syndrome (RLS), though rates of problematic impulsive or compulsive behaviors can be high. Reserve carbidopa/levodopa for intermittent use. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Fluphenazine is an effective, inexpensive first-generation antipsychotic with a long history of experience and use, but clinical utility is limited in some patients due to EPS. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Aripiprazole is a good choice for minimizing risk of weight gain and metabolic side effects, but beware of akathisia. Large number of indications and reports of success at a variety of doses make it difficult to predict dosing for individual patients. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Like Daytrana, Xelstrym is helpful for those 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).

Light therapy is an effective treatment for seasonal affective disorder (SAD) and possibly for nonseasonal depression as well. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Duloxetine is the main SNRI alternative to venlafaxine/desvenlafaxine. It has a niche for depressed patients with various comorbid pain syndromes. However, you should balance this advantage against its potentially serious (though rare) hepatic side effects. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Elevated prolactin levels (>29 ng/mL in nonpregnant, nonlactating women, >18 ng/mL in men) that can cause the following symptoms: ⦁ Women: Menstrual irregularity or amenorrhea, infertility, lowered libido, galactorrhea, decreased bone density, increase or thickening of hair in unexpected areas such as face. ⦁ Men: Breast enlargement (gynecomastia), erectile dysfunction, low libido, infertility, galactorrhea.