Client education

Psychiatric medication guide

Plain-language information about common psychiatric medications — what they treat, how they work, and what to expect.

This guide is for educational purposes only and does not constitute medical advice. Always discuss medication decisions with your provider.

SSRIs SNRIs Atypical Antidepressants TCAs MAOIs Mood Stabilizers Antipsychotics ADHD — Stimulants ADHD — Non-Stimulants Anti-Anxiety Sleep Medications Augmentation & Other MAT / Addiction Anti-Dementia Typical Antipsychotics Newer Treatments

SSRIs

Selective Serotonin Reuptake Inhibitors — the most commonly prescribed antidepressants. First-line treatment for depression and most anxiety disorders.

SertralineBrand: ZoloftDepressionAnxietyOCD+3 more

How it works

Increases serotonin availability in the brain by blocking its reabsorption.

Common side effects

Nausea (early weeks)
Insomnia or drowsiness
Decreased libido
Headache

Timeline

4–6 weeks for full effect; some improvement in 1–2 weeks.

One of the most widely studied and well-tolerated antidepressants. Often considered the default first-line SSRI.

EscitalopramBrand: LexaproDepressionGeneralized Anxiety Disorder

How it works

Selective SSRI — very clean serotonin action with fewer off-target effects.

Common side effects

Nausea
Insomnia
Sexual dysfunction
Dry mouth

Timeline

4–6 weeks for full effect.

Considered one of the most well-tolerated SSRIs with minimal drug interactions.

CitalopramBrand: CelexaDepressionAnxiety (off-label)OCD (off-label)

How it works

Blocks serotonin reuptake with high selectivity.

Common side effects

Nausea
Dry mouth
Sweating
Insomnia

Timeline

4–6 weeks for full effect.

Doses above 40mg not recommended due to cardiac (QT prolongation) risk. Closely related to escitalopram.

FluoxetineBrand: ProzacDepressionOCDPanic Disorder+2 more

How it works

Long-acting SSRI with a very long half-life — missed doses are less problematic.

Common side effects

Nausea
Insomnia
Activation/agitation early on
Sexual dysfunction

Timeline

4–8 weeks for full effect; longer half-life means slower offset too.

The long half-life makes it forgiving if doses are missed and easier to discontinue.

FluvoxamineBrand: LuvoxOCDSocial Anxiety DisorderDepression (off-label)

How it works

SSRI with strong sigma-1 receptor activity — particularly well-studied for OCD.

Common side effects

Nausea
Drowsiness
Insomnia
Dry mouth

Timeline

4–6 weeks for OCD; nausea often improves after the first week.

Has more drug interactions than other SSRIs due to CYP enzyme inhibition. Sigma-1 activity may contribute to anti-inflammatory effects.

ParoxetineBrand: PaxilDepressionGADSocial Anxiety+2 more

How it works

SSRI with some additional anticholinergic and sedating properties.

Common side effects

Sedation
Weight gain
Sexual dysfunction
Constipation

Timeline

4–6 weeks for full effect.

Associated with more discontinuation symptoms due to short half-life — taper slowly.

SNRIs

Serotonin-Norepinephrine Reuptake Inhibitors — work on both serotonin and norepinephrine. Often helpful for pain, fatigue, and anxiety in addition to depression.

VenlafaxineBrand: Effexor XRDepressionGADSocial Anxiety+1 more

How it works

Dual-action on serotonin and norepinephrine. Norepinephrine effects increase with higher doses.

Common side effects

Nausea
Increased blood pressure
Sexual dysfunction
Sweating

Timeline

4–6 weeks for full effect.

Blood pressure monitoring recommended at higher doses. Has significant discontinuation syndrome — taper slowly.

DuloxetineBrand: CymbaltaDepressionGADFibromyalgia+2 more

How it works

Balanced serotonin and norepinephrine reuptake inhibition.

Common side effects

Nausea
Dry mouth
Constipation
Sweating

Timeline

4–6 weeks for depression; pain benefits may take 4–8 weeks.

Useful when pain is a significant component of the clinical picture.

DesvenlafaxineBrand: PristiqDepression

How it works

Active metabolite of venlafaxine — predictable levels without individual metabolism differences.

Common side effects

Nausea
Dizziness
Sweating
Sexual dysfunction

Timeline

4–6 weeks for full effect.

Useful for clients with variable metabolism of venlafaxine (CYP2D6 variations).

LevomilnacipranBrand: FetzimaDepression

How it works

SNRI with stronger norepinephrine than serotonin activity — may improve motivation and energy.

Common side effects

Elevated heart rate
Urinary hesitancy
Nausea
Constipation

Timeline

4–6 weeks for full effect.

The norepinephrine-dominant profile may benefit clients whose depression features fatigue and low motivation.

MilnacipranBrand: SavellaFibromyalgiaDepression (off-label)

How it works

SNRI with roughly equal serotonin/norepinephrine action; approved specifically for fibromyalgia.

Common side effects

Nausea
Headache
Increased blood pressure
Hot flashes

Timeline

Pain relief may begin in 1–2 weeks; full effect at 4–8 weeks.

FDA-approved for fibromyalgia rather than depression in the US.

Atypical Antidepressants

Antidepressants that don't fit neatly into SSRI/SNRI categories — often used for specific symptom profiles or as augmentation.

BupropionBrand: WellbutrinDepressionSeasonal Affective DisorderSmoking Cessation+1 more

How it works

Works on dopamine and norepinephrine — does not affect serotonin.

Common side effects

Insomnia
Dry mouth
Headache
Reduced appetite

Timeline

2–4 weeks for initial effect; full effect in 4–8 weeks.

Generally no sexual side effects; may improve energy. Lowers seizure threshold at high doses. Available in IR, SR, and XL formulations.

MirtazapineBrand: RemeronDepressionAnxietyInsomnia+1 more

How it works

Blocks specific serotonin and histamine receptors — leading to sedation and appetite increase.

Common side effects

Sedation
Weight gain
Dry mouth
Constipation

Timeline

Sleep improvements often seen in week 1; antidepressant effect in 2–4 weeks.

Particularly useful when insomnia, weight loss, or poor appetite are prominent.

TrazodoneBrand: DesyrelDepression (less common)Insomnia

How it works

Serotonin antagonist and reuptake inhibitor — sedating at lower doses.

Common side effects

Sedation
Dizziness
Dry mouth

Timeline

Sleep effects immediate; antidepressant effect requires 4+ weeks at higher doses.

Most commonly prescribed at low doses specifically for sleep.

VilazodoneBrand: ViibrydDepressionAnxiety

How it works

SSRI plus serotonin 5-HT1A partial agonist — dual mechanism similar to combining an SSRI with buspirone.

Common side effects

Diarrhea
Nausea
Insomnia
Vivid dreams

Timeline

4–6 weeks for full effect.

Must be taken with food for adequate absorption. The 5-HT1A activity may reduce anxiety alongside depression.

VortioxetineBrand: TrintellixDepressionCognitive symptoms of depression

How it works

Multimodal — SSRI plus action on multiple serotonin receptor subtypes, improving both mood and cognitive function.

Common side effects

Nausea
Constipation
Vomiting
Sexual dysfunction

Timeline

4–6 weeks for full antidepressant effect; cognitive improvements may begin sooner.

May improve memory, concentration, and processing speed more than other antidepressants. Nausea is common early but usually resolves.

NefazodoneBrand: SerzoneDepressionPTSD (off-label)

How it works

Serotonin antagonist and reuptake inhibitor with norepinephrine reuptake inhibition.

Common side effects

Sedation
Dry mouth
Nausea
Dizziness

Timeline

4–6 weeks for full effect.

Rarely used today due to rare but serious liver toxicity risk. Requires liver function monitoring.

TCAs

Tricyclic Antidepressants — an older class with strong evidence, often used for treatment-resistant depression, chronic pain, migraines, and OCD when newer medications haven't worked.

AmitriptylineBrand: ElavilDepressionChronic PainMigraine Prevention+2 more

How it works

Blocks reuptake of serotonin and norepinephrine while also blocking histamine and muscarinic receptors — contributing to its sedating, pain-modulating properties.

Common side effects

Sedation
Dry mouth
Constipation
Weight gain
Orthostatic hypotension
Urinary retention

Timeline

Antidepressant effect in 2–4 weeks; pain and sleep effects may occur sooner.

One of the most commonly used TCAs for chronic pain and sleep. Anticholinergic side effects are more pronounced than with newer antidepressants. EKG monitoring recommended at higher doses.

NortriptylineBrand: PamelorDepressionChronic PainMigraine Prevention+1 more

How it works

Active metabolite of amitriptyline — predominantly norepinephrine reuptake inhibition with less anticholinergic activity.

Common side effects

Dry mouth
Sedation
Constipation
Dizziness
Weight gain

Timeline

2–4 weeks for antidepressant effect.

Generally better tolerated than amitriptyline due to less anticholinergic burden. Therapeutic blood level monitoring available. Often preferred TCA for elderly patients.

ImipramineBrand: TofranilDepressionPanic DisorderEnuresis (bedwetting in children)+1 more

How it works

Blocks serotonin and norepinephrine reuptake — balanced dual action similar to SNRIs but with additional receptor effects.

Common side effects

Dry mouth
Sedation
Constipation
Orthostatic hypotension
Cardiac effects

Timeline

2–4 weeks for antidepressant effect.

One of the first antidepressants — historically important. Still used for panic disorder and pediatric enuresis when other options fail. EKG monitoring required.

ClomipramineBrand: AnafranilOCDDepressionPanic Disorder+1 more

How it works

Strong serotonin reuptake inhibition — more serotonergic than other TCAs; responsible for its superior OCD efficacy.

Common side effects

Sedation
Dry mouth
Constipation
Weight gain
Sexual dysfunction
Tremor

Timeline

4–8 weeks for full OCD effect.

Considered one of the most effective medications for OCD — even more so than SSRIs for some patients. The serotonergic activity comes at the cost of more side effects.

DesipramineBrand: NorpraminDepressionADHD (off-label)Chronic Pain+1 more

How it works

Predominantly norepinephrine reuptake inhibitor — among the least sedating TCAs.

Common side effects

Dry mouth
Insomnia", "Increased heart rate
Constipation

Timeline

2–4 weeks for antidepressant effect.

Least sedating and least anticholinergic TCA. Blood level monitoring recommended. Has been studied for ADHD when stimulants aren't appropriate.

DoxepinBrand: Sinequan, SilenorDepressionAnxietyInsomnia (low-dose)+1 more

How it works

Potent histamine H1 antagonist at low doses promoting sleep; at higher doses acts as full TCA antidepressant.

Common side effects

Sedation
Dry mouth
Weight gain
Constipation

Timeline

Sleep benefit is immediate at low doses; antidepressant effect takes 2–4 weeks.

FDA-approved at low doses (3–6mg, branded as Silenor) specifically for insomnia. At full antidepressant doses, has a typical TCA side effect profile.

MAOIs

Monoamine Oxidase Inhibitors — powerful antidepressants usually reserved for treatment-resistant cases due to dietary restrictions and drug interactions.

PhenelzineBrand: NardilTreatment-Resistant DepressionSocial Anxiety DisorderAtypical Depression+1 more

How it works

Irreversibly inhibits both MAO-A and MAO-B enzymes, increasing serotonin, norepinephrine, and dopamine levels.

Common side effects

Weight gain
Insomnia
Sexual dysfunction
Orthostatic hypotension
Fatigue

Timeline

2–4 weeks for initial response; up to 6 weeks for full effect.

Requires strict tyramine-restricted diet (no aged cheeses, cured meats, certain wines) to avoid hypertensive crisis. Many drug interactions.

TranylcypromineBrand: ParnateTreatment-Resistant DepressionAtypical Depression

How it works

Irreversible, non-selective MAO inhibitor — amphetamine-like structure may add stimulant qualities.

Common side effects

Insomnia
Orthostatic hypotension
Headache
Dry mouth

Timeline

Often faster onset than phenelzine — some response in 1–2 weeks.

Tyramine restriction required. More activating than phenelzine; may be better tolerated by some.

Selegiline PatchBrand: EmsamDepression

How it works

Selective MAO-B inhibitor at low doses — the transdermal patch bypasses gut absorption, reducing dietary tyramine concerns.

Common side effects

Application site reactions
Insomnia
Diarrhea
Dry mouth

Timeline

4–6 weeks for full effect.

At the lowest dose (6mg/24hr), dietary restrictions may not be required. More convenient than oral MAOIs for many clients.

Mood Stabilizers

Used primarily for bipolar disorder to prevent mood episodes. Some are also used for augmentation in treatment-resistant depression.

LithiumBrand: LithobidBipolar DisorderTreatment-Resistant Depression (augmentation)

How it works

Complex mechanism affecting multiple neurotransmitter systems; also has neuroprotective and anti-suicidal effects.

Common side effects

Tremor
Thirst/increased urination
Weight gain
Cognitive slowing

Timeline

Mood stabilization over weeks to months.

Requires regular blood level monitoring and thyroid/kidney function checks. Narrow therapeutic window. Strong evidence for reducing suicide risk.

ValproateBrand: DepakoteBipolar DisorderAcute ManiaSeizures+1 more

How it works

Increases GABA activity and affects sodium channels.

Common side effects

Weight gain
Tremor
Sedation
Hair thinning
Liver effects

Timeline

Acute mania may respond within 1–2 weeks.

Requires liver function and blood level monitoring. Contraindicated in pregnancy (teratogenic). Extended-release form (Depakote ER) often better tolerated.

LamotrigineBrand: LamictalBipolar DepressionBipolar Disorder MaintenanceSeizures

How it works

Stabilizes sodium channels and inhibits glutamate release.

Common side effects

Headache
Dizziness
Blurred vision
Rash

Timeline

Takes 8–12 weeks due to mandatory slow titration.

Must titrate very slowly to minimize risk of serious rash (Stevens-Johnson Syndrome). Highly effective for bipolar depression — better than mania.

CarbamazepineBrand: TegretolBipolar DisorderSeizuresTrigeminal Neuralgia

How it works

Sodium channel blocker that stabilizes nerve membranes.

Common side effects

Dizziness
Drowsiness
Nausea
Blurred vision
Low sodium (hyponatremia)

Timeline

Mood effects may emerge in 1–2 weeks.

Requires CBC and electrolyte monitoring. Induces its own metabolism (autoinduction) — doses often need adjustment. Many drug interactions.

OxcarbazepineBrand: TrileptalBipolar Disorder (off-label)Seizures

How it works

Related to carbamazepine — sodium channel blockade with fewer drug interactions.

Common side effects

Dizziness
Fatigue
Low sodium
Nausea

Timeline

Similar to carbamazepine.

Better tolerated than carbamazepine with fewer drug interactions. Sodium levels (hyponatremia) should be monitored.

Antipsychotics

Used for psychosis, schizophrenia, bipolar disorder, and as augmentation for depression and anxiety when other treatments have been insufficient.

QuetiapineBrand: SeroquelBipolar DisorderSchizophreniaDepression (augmentation)+1 more

How it works

Blocks multiple dopamine and serotonin receptors. Antihistamine properties contribute to sedation.

Common side effects

Sedation
Weight gain
Metabolic effects
Dizziness
Dry mouth

Timeline

Sedation immediate; antipsychotic/mood effects over weeks.

Metabolic monitoring (weight, glucose, lipids) recommended. XR formulation preferred for mood disorders.

AripiprazoleBrand: AbilifySchizophreniaBipolar DisorderDepression (augmentation)+2 more

How it works

Dopamine partial agonist — balances dopamine rather than simply blocking it.

Common side effects

Akathisia (restlessness)
Nausea
Insomnia
Headache

Timeline

Weeks for full effect.

Generally better metabolic profile than most antipsychotics. Akathisia (inner restlessness) can be distressing for some.

BrexpiprazoleBrand: RexultiDepression (augmentation)SchizophreniaAgitation in Alzheimer's Disease

How it works

Dopamine/serotonin partial agonist — similar mechanism to aripiprazole but with less akathisia.

Common side effects

Weight gain
Fatigue
Restlessness
Nasopharyngitis

Timeline

Weeks for full effect.

Better akathisia profile than aripiprazole. FDA-approved specifically as an antidepressant augmentation agent.

CariprazineBrand: VraylarSchizophreniaBipolar ManiaBipolar Depression+1 more

How it works

D3/D2 partial agonist — strong D3 activity may improve cognitive symptoms and negative symptoms.

Common side effects

Akathisia
Restlessness
Nausea
Insomnia

Timeline

Weeks for full antipsychotic effect; bipolar depression response may occur in 1–2 weeks.

The D3 receptor activity may particularly help with negative symptoms and cognitive dysfunction.

RisperidoneBrand: RisperdalSchizophreniaBipolar DisorderIrritability in Autism

How it works

Blocks dopamine D2 and serotonin 5-HT2A receptors.

Common side effects

Weight gain
Elevated prolactin
EPS (movement side effects)
Sedation

Timeline

Weeks for full effect.

Prolactin elevation can cause menstrual irregularities and sexual side effects. Available as long-acting injectable (Risperdal Consta).

PaliperidoneBrand: InvegaSchizophreniaSchizoaffective Disorder

How it works

Active metabolite of risperidone — similar mechanism with more predictable levels.

Common side effects

Elevated prolactin
EPS
Weight gain
Tachycardia

Timeline

Weeks for full effect.

Available as long-acting injectables (monthly Invega Sustenna, 3-month Invega Trinza) for adherence support.

OlanzapineBrand: ZyprexaSchizophreniaBipolar DisorderTreatment-Resistant Depression (with fluoxetine)

How it works

Broad receptor blockade — dopamine, serotonin, histamine, and muscarinic receptors.

Common side effects

Significant weight gain
Metabolic syndrome risk
Sedation
Dry mouth

Timeline

Sedation immediate; full antipsychotic effect over weeks.

Highly effective but associated with the most significant metabolic side effects of all atypicals. Careful monitoring required.

ZiprasidoneBrand: GeodonSchizophreniaBipolar Disorder

How it works

Dopamine and serotonin receptor antagonist.

Common side effects

QTc prolongation
Sedation
Nausea
Dizziness

Timeline

Weeks for full effect.

Must be taken with food (500+ calories). Requires EKG monitoring due to QT prolongation risk.

ClozapineBrand: ClozarilTreatment-Resistant SchizophreniaSuicidality in Schizophrenia/Schizoaffective Disorder

How it works

Broad multi-receptor antagonist — mechanism of superiority in treatment-resistant cases not fully understood.

Common side effects

Agranulocytosis (rare but serious)
Sedation
Significant weight gain
Hypersalivation
Seizures

Timeline

Full benefit may take months.

Reserved for treatment-resistant cases. Requires mandatory weekly-to-monthly CBC monitoring due to risk of agranulocytosis (low white blood cells). Gold standard for persistent suicidality.

LurasidoneBrand: LatudaSchizophreniaBipolar Depression

How it works

Blocks dopamine D2 and serotonin receptors with minimal histamine/muscarinic activity.

Common side effects

Nausea
Somnolence
Akathisia

Timeline

Weeks for full effect.

Must be taken with food (350+ calories). Favorable weight and metabolic profile.

ADHD — Stimulants

First-line treatment for ADHD. Controlled substances requiring ongoing monitoring. Highly effective when appropriately prescribed.

Amphetamine/DextroamphetamineBrand: Adderall, Adderall XRADHDNarcolepsy

How it works

Increases dopamine and norepinephrine by stimulating release and blocking reuptake.

Common side effects

Decreased appetite
Insomnia
Increased heart rate/BP
Anxiety

Timeline

Effect felt within 30–60 minutes (IR); XR lasts 8–12 hours.

Schedule II controlled substance. Requires monitoring of heart rate, blood pressure, and psychiatric symptoms.

LisdexamfetamineBrand: VyvanseADHDBinge Eating Disorder

How it works

Prodrug converted to dextroamphetamine in the body — smoother onset and lower abuse potential.

Common side effects

Decreased appetite
Insomnia
Dry mouth
Irritability

Timeline

Effect begins in 1–2 hours; lasts up to 14 hours.

Schedule II. The prodrug design produces more consistent, predictable levels. FDA-approved for binge eating disorder as well as ADHD.

MethylphenidateBrand: Ritalin, Concerta, MetadateADHD

How it works

Blocks reuptake of dopamine and norepinephrine.

Common side effects

Decreased appetite
Insomnia
Headache
Stomach upset

Timeline

IR: onset 20–30 min, lasts 4–6 hours. Concerta ER: 10–12 hours.

Schedule II. Often tried first before amphetamines. Many formulations available.

DexmethylphenidateBrand: Focalin, Focalin XRADHD

How it works

Active d-isomer of methylphenidate — may be effective at lower doses than racemic methylphenidate.

Common side effects

Decreased appetite
Insomnia
Headache
Stomachache

Timeline

Onset 30–45 min; XR lasts 8–10 hours.

Schedule II. Some clients tolerate it better than racemic methylphenidate.

MethamphetamineBrand: DesoxynADHDObesity (short-term)

How it works

Potent CNS stimulant — same mechanism as amphetamine with higher CNS penetration.

Common side effects

Significant appetite suppression
Insomnia
Increased BP/HR
Anxiety

Timeline

Effect within 30–60 minutes.

Schedule II. Rarely prescribed due to high abuse potential. Only considered when other stimulants have failed.

ADHD — Non-Stimulants

Non-controlled ADHD medications. Slower onset than stimulants but valuable when stimulants are contraindicated, poorly tolerated, or ineffective.

AtomoxetineBrand: StratteraADHD

How it works

Selective norepinephrine reuptake inhibitor — not a stimulant.

Common side effects

Decreased appetite
Nausea
Dry mouth
Fatigue initially

Timeline

4–8 weeks for full effect — slower than stimulants.

Not a controlled substance. Good option when stimulants aren't appropriate or preferred. Also approved for adults.

ViloxazineBrand: QelbreeADHD

How it works

Selective norepinephrine reuptake inhibitor with additional serotonin receptor activity.

Common side effects

Somnolence
Headache
Decreased appetite
Nausea

Timeline

4–6 weeks for full effect.

Newest non-stimulant ADHD medication (FDA-approved 2021). Can increase levels of other medications — check interactions.

Guanfacine ERBrand: IntunivADHDTic Disorders (off-label)Anxiety (off-label)

How it works

Alpha-2A adrenergic receptor agonist — reduces norepinephrine signaling in the prefrontal cortex to improve attention and impulse control.

Common side effects

Sedation
Fatigue
Decreased blood pressure
Dry mouth

Timeline

3–4 weeks for full effect.

Particularly useful for emotional dysregulation and hyperactivity in ADHD. Also used as augmentation with stimulants. Do not stop abruptly — rebound hypertension.

Clonidine ERBrand: KapvayADHDTic DisordersHypertension

How it works

Alpha-2 adrenergic agonist — similar to guanfacine but less receptor-selective.

Common side effects

Sedation (more than guanfacine)
Decreased blood pressure
Dry mouth
Dizziness

Timeline

2–4 weeks for full effect.

More sedating than guanfacine. Must be tapered — abrupt discontinuation can cause rebound hypertension. Often used at bedtime for sleep and nighttime hyperarousal.

Anti-Anxiety

Medications used specifically for anxiety. Includes non-habit-forming options as well as controlled substances used carefully for acute symptoms.

GabapentinBrand: NeurontinAnxiety (off-label)Neuropathic PainSeizures+2 more

How it works

Binds to the alpha-2-delta subunit of voltage-gated calcium channels — reduces excitatory neurotransmitter release and neuronal hyperexcitability.

Common side effects

Sedation
Dizziness
Ataxia (coordination problems)
Weight gain
Peripheral edema
Cognitive blunting

Timeline

Anxiolytic effects may be felt within 1–2 weeks; pain effects often sooner.

Not FDA-approved for anxiety but widely used off-label, especially for social anxiety, PTSD-related hyperarousal, and alcohol use disorder adjunctive treatment. Abuse potential is increasing — use caution in patients with substance use history. Not a controlled substance federally but scheduled in some states.

BuspironeBrand: BusparGeneralized Anxiety DisorderAnxiety augmentation

How it works

Serotonin 5-HT1A receptor partial agonist — non-sedating, no dependence risk.

Common side effects

Dizziness
Nausea
Headache
Nervousness initially

Timeline

2–4 weeks for anxiolytic effect — not immediate.

Not useful for acute anxiety or panic attacks. No abuse potential. Can be combined with SSRIs for added anxiety relief.

HydroxyzineBrand: Vistaril, AtaraxAnxietyInsomniaItching

How it works

Antihistamine with anxiolytic properties.

Common side effects

Sedation
Dry mouth
Blurred vision

Timeline

Immediate effect within 30–60 minutes.

Non-controlled, non-habit forming. Useful for situational anxiety, panic attacks, or as-needed sleep aid.

PregabalinBrand: LyricaGeneralized Anxiety DisorderNeuropathic PainFibromyalgia+1 more

How it works

Binds to voltage-gated calcium channels — reducing release of excitatory neurotransmitters.

Common side effects

Dizziness
Sedation
Weight gain
Blurred vision
Edema

Timeline

Anxiety relief may begin in 1–2 weeks.

Controlled substance (Schedule V) but lower abuse potential than benzodiazepines. Good evidence for GAD when SSRIs aren't sufficient.

PropranololBrand: InderalPerformance Anxiety (situational)TremorHypertension

How it works

Beta-blocker that reduces the physical symptoms of anxiety (racing heart, sweating, shaking).

Common side effects

Fatigue
Cold extremities
Bradycardia
Dizziness

Timeline

Immediate — works within 30–60 minutes for acute situational use.

Does not treat the psychological aspects of anxiety. Best for specific situations (public speaking, performances). Contraindicated in asthma.

ClonazepamBrand: KlonopinPanic DisorderAnxietySeizures

How it works

Benzodiazepine that enhances GABA activity — longer half-life provides sustained effects.

Common side effects

Sedation
Cognitive impairment
Dependence risk
Memory problems

Timeline

Effect within 30–60 minutes.

Controlled substance with dependence and withdrawal risk. Longer half-life makes it smoother than shorter-acting benzos. Generally reserved for short-term or as-needed use.

LorazepamBrand: AtivanAcute AnxietyPanic AttacksAcute Agitation+1 more

How it works

Benzodiazepine — enhances GABA inhibitory activity.

Common side effects

Sedation
Dizziness
Cognitive impairment
Dependence risk

Timeline

Onset 15–30 minutes; duration 6–8 hours.

Schedule IV. No active metabolites — predictable even in elderly or those with liver issues. Must be tapered to avoid severe withdrawal.

DiazepamBrand: ValiumAnxietyMuscle SpasmsAlcohol Withdrawal+1 more

How it works

Long-acting benzodiazepine with active metabolites extending its duration.

Common side effects

Prolonged sedation
Cognitive impairment
Dependence

Timeline

Onset 15–60 minutes; effects may persist 1–3 days due to active metabolites.

Very long half-life makes it useful for alcohol withdrawal but requires care in elderly due to accumulation.

Sleep Medications

Medications prescribed specifically for insomnia. Includes multiple classes with different mechanisms, risk profiles, and appropriate use cases.

ZolpidemBrand: Ambien, Ambien CRInsomnia (sleep onset and/or maintenance)

How it works

Non-benzodiazepine GABA-A receptor modulator — primarily enhances sleep onset.

Common side effects

Daytime drowsiness
Memory impairment
Sleepwalking/complex sleep behaviors
Dizziness

Timeline

Works immediately — take 30 minutes before bed.

Schedule IV. Women prescribed lower doses than men due to slower metabolism. Complex sleep behaviors (sleepwalking, sleep driving) are rare but serious.

EszopicloneBrand: LunestaInsomnia

How it works

Non-benzodiazepine GABA-A modulator — approved for longer-term use than zolpidem.

Common side effects

Unpleasant taste
Dizziness
Daytime drowsiness
Dry mouth

Timeline

Works immediately — onset within 30 minutes.

Schedule IV. Only sleep medication FDA-approved without a duration-of-use restriction. Metallic/bitter taste common.

SuvorexantBrand: BelsomraInsomnia

How it works

Orexin receptor antagonist — blocks the wake-promoting orexin system rather than sedating.

Common side effects

Somnolence
Abnormal dreams
Headache
Dizziness

Timeline

Works immediately — take 30 minutes before bed.

Unique mechanism with lower abuse potential than traditional sleep aids. May be better for clients who can't fall asleep because their brain stays alert.

LemborexantBrand: DayvigoInsomnia

How it works

Dual orexin receptor antagonist — blocks wake-promoting signals.

Common side effects

Somnolence
Headache
Dizziness
Unusual dreams

Timeline

Immediate effect — take within 30 minutes of bedtime.

Schedule IV. Newer dual orexin antagonist with strong evidence for both sleep onset and maintenance. Less next-day impairment than some sleep aids.

RamelteonBrand: RozeremInsomnia (sleep onset)Circadian Rhythm Disorders

How it works

Melatonin receptor agonist — promotes sleep by acting on the body's natural sleep-wake circadian rhythm.

Common side effects

Drowsiness
Dizziness
Fatigue
Nausea

Timeline

Best taken 30 minutes before bed. Full benefit may develop over weeks.

Not a controlled substance — no abuse potential. Particularly useful for circadian disruption and older adults who should avoid benzodiazepines.

Doxepin (low-dose)Brand: SilenorInsomnia (sleep maintenance)

How it works

Tricyclic antidepressant at full doses; at low doses (3–6mg), histamine H1 blockade promotes sleep maintenance.

Common side effects

Somnolence
Nausea
Dry mouth

Timeline

Immediate sleep-maintenance benefit.

Not a controlled substance. FDA-approved specifically at low doses for sleep. Effective for waking up in the middle of the night and not returning to sleep.

TemazepamBrand: RestorilInsomnia

How it works

Benzodiazepine that decreases sleep onset time and increases total sleep time.

Common side effects

Daytime drowsiness
Dizziness
Headache
Dependence risk

Timeline

Take 30 minutes before bed; onset within 30 minutes.

Schedule IV. Not recommended for long-term use due to dependence risk and rebound insomnia on discontinuation.

Augmentation & Other

Medications that enhance the effects of primary treatments, address specific symptoms, or serve specialized purposes in psychiatric care.

PrazosinBrand: MinipressPTSD NightmaresHypertension

How it works

Alpha-1 adrenergic receptor blocker — reduces norepinephrine-driven hyperarousal during sleep.

Common side effects

Dizziness (especially first-dose)
Orthostatic hypotension
Nasal congestion
Fatigue

Timeline

Nightmare reduction may occur in the first 1–2 weeks.

Non-controlled, evidence-based treatment for PTSD-related nightmares. Start at bedtime at low dose and titrate to minimize dizziness.

NaltrexoneBrand: Vivitrol (injectable), ReVia (oral)Alcohol Use DisorderOpioid Use DisorderLow-Dose (LDN) for Depression/Fibromyalgia (off-label)

How it works

Opioid receptor antagonist — blocks the rewarding effects of alcohol and opioids.

Common side effects

Nausea
Headache
Fatigue
Stomach upset

Timeline

Craving reduction within days to weeks.

Must be opioid-free for 7–10 days before starting to avoid precipitated withdrawal. Monthly injectable (Vivitrol) improves adherence. Low-dose naltrexone (LDN) is an emerging off-label use.

N-Acetylcysteine (NAC)Brand: Various OTC brandsOCD (augmentation)TrichotillomaniaSubstance Use (adjunct)+1 more

How it works

Antioxidant and glutamate modulator — reduces compulsive behaviors by restoring glutamate balance.

Common side effects

Nausea
Diarrhea
Stomach upset
Headache

Timeline

8–12 weeks for behavioral effects.

Available OTC but often used as a psychiatric augmentation agent. Best evidence in OCD and repetitive-behavior conditions. Generally well tolerated.

Thyroid Hormone (T3)Brand: Cytomel (Liothyronine)Treatment-Resistant Depression (augmentation)

How it works

Thyroid hormone that amplifies antidepressant response — mechanism not fully understood.

Common side effects

Increased heart rate
Anxiety
Sweating
Weight loss

Timeline

Augmentation effect may emerge in 2–4 weeks.

Used even in clients with normal thyroid function to augment antidepressants. Thyroid function monitoring required.

EsketamineBrand: SpravatoTreatment-Resistant DepressionMajor Depressive Disorder with Suicidality

How it works

NMDA receptor antagonist (nasal spray) — rapidly modulates glutamate signaling, restoring synaptic connections depleted by chronic depression.

Common side effects

Dissociation (during administration)
Dizziness
Nausea
Sedation
Increased blood pressure (transient)

Timeline

Rapid — many patients notice improvement within hours to days, unlike 4–6 weeks for traditional antidepressants.

Administered in a certified healthcare setting (REMS program). Patient must be monitored for 2 hours after each dose. Typically combined with an oral antidepressant. A landmark treatment option for patients who haven't responded to multiple medications.

ModafinilBrand: ProvigilNarcolepsyShift Work DisorderFatigue in Depression (augmentation, off-label)+1 more

How it works

Wakefulness-promoting agent — exact mechanism unclear but involves dopamine and orexin pathways.

Common side effects

Headache
Nausea
Anxiety
Insomnia

Timeline

Wakefulness effects immediate; augmentation benefits may take weeks.

Schedule IV. Lower abuse potential than traditional stimulants. May reduce fatigue and cognitive slowing associated with depression or antipsychotic treatment.

TopiramateBrand: TopamaxBipolar Disorder (adjunct, off-label)Migraine PreventionAlcohol Use Disorder (off-label)+1 more

How it works

Multiple mechanisms including GABA enhancement, glutamate reduction, and carbonic anhydrase inhibition.

Common side effects

Cognitive slowing ("Dopamax")
Weight loss
Tingling in hands/feet
Kidney stones

Timeline

Weeks for full effect.

Cognitive side effects (word-finding difficulty) are common and often dose-limiting. The weight-loss effect can be therapeutic in certain clients.

MAT / Addiction

Medication-Assisted Treatment (MAT) medications are FDA-approved to treat opioid use disorder (OUD) and alcohol use disorder (AUD). They reduce cravings, prevent relapse, and improve outcomes when combined with counseling.

BuprenorphineBrand: Suboxone (with naloxone), Sublocade (injectable), SubutexOpioid Use DisorderChronic Pain (off-label)

How it works

Partial opioid agonist — activates opioid receptors enough to prevent withdrawal and cravings without causing a full high. The naloxone added in Suboxone deters misuse by injection.

Common side effects

Constipation
Headache
Nausea
Sweating
Insomnia

Timeline

Craving reduction begins within hours; stabilization typically over days to weeks.

One of the most evidence-based treatments for OUD. Can be prescribed in outpatient settings. Monthly injectable (Sublocade) eliminates daily dosing. Do not start until patient is in mild-to-moderate withdrawal to avoid precipitated withdrawal.

MethadoneBrand: Methadose, DolophineOpioid Use DisorderSevere Chronic Pain

How it works

Full opioid agonist — long-acting (24–36 hrs) that prevents withdrawal and blocks the effects of other opioids at the receptor level.

Common side effects

Constipation
Sweating
Sexual dysfunction
QT prolongation (cardiac risk)
Weight gain

Timeline

Stabilization over days to weeks; optimal dose takes 4–6 weeks to establish.

Dispensed only at licensed Opioid Treatment Programs (OTPs/clinics). High effectiveness but requires more oversight due to cardiac risks (QT prolongation) and overdose risk during induction. ECG monitoring recommended.

Naltrexone (MAT)Brand: Vivitrol (monthly injection), ReVia (oral)Opioid Use DisorderAlcohol Use Disorder

How it works

Opioid receptor antagonist — completely blocks opioid receptors so opioids produce no euphoric effect. Reduces alcohol craving through endorphin pathway blockade.

Common side effects

Nausea
Headache
Fatigue
Injection site reactions (Vivitrol)
Stomach upset

Timeline

Craving reduction within days to weeks.

Patient must be opioid-free for 7–10 days before starting to avoid precipitated withdrawal. Monthly Vivitrol injectable improves adherence and eliminates the need for daily pills. No abuse potential.

DisulfiramBrand: AntabuseAlcohol Use Disorder

How it works

Blocks aldehyde dehydrogenase — causes an unpleasant reaction (flushing, nausea, racing heart) when alcohol is consumed, creating a deterrent.

Common side effects

Drowsiness
Headache
Metallic aftertaste
Severe reaction with any alcohol exposure

Timeline

Deterrent effect is immediate once steady-state is reached (within days).

Requires strong patient motivation — effectiveness depends on adherence. Patients must avoid all alcohol including in foods, mouthwash, and topical products. A medical emergency can occur if alcohol is consumed while on this medication.

AcamprosateBrand: CampralAlcohol Use Disorder (maintaining abstinence)

How it works

Restores the balance between glutamate (excitatory) and GABA (inhibitory) systems disrupted by chronic alcohol use — reduces the discomfort of prolonged abstinence.

Common side effects

Diarrhea
Nausea
Stomach upset
Anxiety

Timeline

Best initiated at the point of abstinence; benefits may take several weeks.

Does not prevent the acute alcohol withdrawal syndrome — should be started after detox. Unlike naltrexone, does not require opioid-free period. Three-times-daily dosing can affect adherence. Works best combined with counseling.

Anti-Dementia

Medications used to treat Alzheimer's disease and other dementias. They do not stop disease progression but can temporarily improve or stabilize cognitive symptoms and daily functioning.

DonepezilBrand: AriceptAlzheimer's Disease (mild to severe)Other Dementias (off-label)

How it works

Acetylcholinesterase inhibitor — increases acetylcholine levels in the brain by blocking the enzyme that breaks it down. Acetylcholine is critical for memory and learning.

Common side effects

Nausea
Diarrhea
Insomnia (take in morning if problematic)
Muscle cramps
Vivid dreams

Timeline

Cognitive effects may be noticeable in 4–6 weeks; benefits are often modest and gradual.

First-line treatment for all stages of Alzheimer's. Once-daily dosing at bedtime (or morning if nightmares occur). GI side effects usually resolve in 1–2 weeks. Available in 5 mg and 10 mg tablets and orally disintegrating form.

RivastigmineBrand: ExelonAlzheimer's Disease (mild to moderate)Parkinson's Disease Dementia

How it works

Dual acetylcholinesterase and butyrylcholinesterase inhibitor — blocks both enzymes that break down acetylcholine, potentially with broader effect than donepezil.

Common side effects

Nausea and vomiting (common early)
Weight loss
Dizziness
Decreased appetite

Timeline

Cognitive benefits emerge over weeks to months.

Available as an oral capsule and transdermal patch. The patch significantly reduces GI side effects and is often preferred. Also FDA-approved for Parkinson's disease dementia — a unique distinction among this class.

GalantamineBrand: RazadyneAlzheimer's Disease (mild to moderate)

How it works

Acetylcholinesterase inhibitor plus allosteric modulation of nicotinic acetylcholine receptors — the additional nicotinic modulation may provide added benefit.

Common side effects

Nausea
Vomiting
Diarrhea
Dizziness
Headache

Timeline

Effects typically seen over weeks with gradual dose increases.

Extended-release formulation available for once-daily dosing. GI tolerability is similar to donepezil. The nicotinic receptor activity distinguishes it mechanistically from the other cholinesterase inhibitors.

MemantineBrand: NamendaAlzheimer's Disease (moderate to severe)Vascular Dementia (off-label)

How it works

NMDA receptor antagonist — blocks excessive glutamate activity that causes neuronal damage in moderate-to-severe Alzheimer's. Works through a completely different mechanism than cholinesterase inhibitors.

Common side effects

Dizziness
Headache
Constipation
Confusion (can worsen transiently)
Fatigue

Timeline

Stabilization of decline over weeks to months.

Often prescribed in combination with a cholinesterase inhibitor (Namzaric = donepezil + memantine). Best evidence in moderate-to-severe stages. Less GI burden than cholinesterase inhibitors.

LecanemabBrand: LeqembiEarly Alzheimer's Disease (mild cognitive impairment or mild dementia stage)

How it works

Monoclonal antibody that targets and clears amyloid-beta plaques from the brain — addresses the underlying pathology rather than just symptoms.

Common side effects

Amyloid-related imaging abnormalities (ARIA — brain swelling or microbleeds)
Headache
Infusion reactions
Falls

Timeline

Disease-modifying effects seen over 18 months of treatment in clinical trials.

FDA-approved July 2023. First disease-modifying Alzheimer's treatment. Requires IV infusion every two weeks and regular MRI monitoring for ARIA. Appropriate only for patients with confirmed amyloid pathology at early disease stages. Significant cost and access barriers.

Typical Antipsychotics

First-generation (typical) antipsychotics — the original class developed in the 1950s–60s. They primarily block dopamine D2 receptors and are highly effective for psychosis, but carry a higher risk of movement side effects (EPS) than newer antipsychotics.

HaloperidolBrand: HaldolSchizophreniaAcute PsychosisBipolar Mania (adjunct)+2 more

How it works

Potent D2 dopamine receptor antagonist — rapidly reduces positive psychotic symptoms (hallucinations, delusions) by blocking dopamine in mesolimbic pathways.

Common side effects

Extrapyramidal symptoms (EPS) — rigidity, tremor, restlessness
Tardive dyskinesia (long-term risk)
Sedation
Orthostatic hypotension
QT prolongation

Timeline

Acute effects (sedation, calming) within hours; antipsychotic effect over days to weeks.

Available in oral, IM, and long-acting injectable (Haldol Decanoate monthly or every 4 weeks) formulations. Very effective for acute agitation and delirium in medical settings. High EPS risk; often co-prescribed with benztropine or diphenhydramine to prevent acute dystonia.

PerphenazineBrand: TrilafonSchizophreniaSevere Nausea/VomitingPsychotic Agitation

How it works

Mid-potency D2 antagonist — moderate affinity for dopamine receptors; lower EPS risk than haloperidol, more sedation.

Common side effects

EPS (moderate risk)
Sedation
Anticholinergic effects (dry mouth, constipation)
Tardive dyskinesia

Timeline

Antipsychotic effect over days to weeks.

Studied in the landmark CATIE trial (2005) alongside atypical antipsychotics. Showed similar effectiveness to several second-generation antipsychotics with better metabolic tolerability. A reasonable option when cost is a consideration.

FluphenazineBrand: ProlixinSchizophreniaPsychotic Disorders

How it works

High-potency D2 antagonist — similar mechanism to haloperidol with high affinity for dopamine receptors.

Common side effects

High EPS risk
Akathisia (restlessness)
Tardive dyskinesia
Low sedation at therapeutic doses

Timeline

Antipsychotic effects over days to weeks.

Available in long-acting injectable (Prolixin Decanoate, every 2–3 weeks) — an important option for patients with adherence challenges. Less sedating than lower-potency typicals (e.g., chlorpromazine) at equivalent antipsychotic doses.

ChlorpromazineBrand: ThorazineSchizophreniaBipolar ManiaIntractable Hiccups+1 more

How it works

Low-potency D2 antagonist with broad receptor blockade (histamine, muscarinic, alpha-adrenergic) — causes significant sedation and anticholinergic effects.

Common side effects

High sedation
Orthostatic hypotension
Anticholinergic effects (dry mouth, urinary retention)
Photosensitivity
Lower EPS risk than high-potency agents

Timeline

Sedating effects immediate; antipsychotic effects over days to weeks.

The first antipsychotic ever developed (1952). Less commonly prescribed today due to adverse effect profile. Still useful for intractable hiccups (unique indication). Patients should use sunscreen due to photosensitivity.

ThiothixeneBrand: NavaneSchizophreniaAcute Psychosis

How it works

High-potency D2 receptor antagonist — similar profile to haloperidol and fluphenazine.

Common side effects

High EPS risk
Akathisia
Tardive dyskinesia
Sedation
Orthostatic hypotension

Timeline

Antipsychotic effects over days to weeks.

Used primarily when patients have not responded to or cannot tolerate other antipsychotics. High EPS risk warrants prophylactic anticholinergic coverage. Less commonly used since the advent of atypical antipsychotics.

LoxapineBrand: Loxitane, Adasuve (inhaled)SchizophreniaAcute Agitation in Schizophrenia or Bipolar (inhaled form)

How it works

Mid-potency D2 antagonist with some D4, 5-HT2, and H1 receptor activity — has a pharmacological profile that bridges first- and second-generation antipsychotics.

Common side effects

EPS (moderate risk)
Sedation
Anticholinergic effects
Bronchospasm risk with inhaled form

Timeline

Inhaled Adasuve: onset within 10 minutes for acute agitation. Oral: days to weeks.

Adasuve (inhaled loxapine) is FDA-approved for acute agitation and can be used in emergency or controlled clinic settings. Requires REMS certification due to bronchospasm risk. Oral form is less commonly used but still available.

Newer Treatments

Recently FDA-approved medications and emerging treatments that represent advances in psychiatric pharmacology — including fast-acting, novel-mechanism options for treatment-resistant conditions.

AuvelityBrand: Dextromethorphan/BupropionMajor Depressive Disorder

How it works

First-in-class NMDA receptor antagonist + sigma-1 receptor agonist combined with bupropion (which extends its half-life). Acts on glutamate and opioid pathways — completely different from SSRIs/SNRIs.

Common side effects

Dizziness
Headache
Diarrhea
Somnolence
Dry mouth

Timeline

Notably faster than SSRIs — some studies show improvement in 1–2 weeks.

FDA-approved 2022. First oral NMDA receptor antagonist for depression. The bupropion component inhibits CYP2D6 — check drug interactions. An important option for patients who haven't responded to or can't tolerate SSRIs/SNRIs.

BrexanoloneBrand: ZulressoPostpartum Depression

How it works

Synthetic neurosteroid that modulates GABA-A receptors — the same pathway affected by natural progesterone metabolites that drop sharply after childbirth.

Common side effects

Sedation
Dizziness
Loss of consciousness (rare)
Flushing
Dry mouth

Timeline

Rapid — significant improvement often seen during the 60-hour IV infusion.

First FDA-approved treatment specifically for postpartum depression (PPD). Administered as a single 60-hour IV infusion in a certified healthcare facility. Expensive and logistically complex, but transformative for severe PPD.

ZuranoloneBrand: ZurzuvaeMajor Depressive DisorderPostpartum Depression

How it works

Oral neuroactive steroid GABA-A receptor positive modulator — same mechanism as brexanolone but taken as a once-daily pill for 14 days.

Common side effects

Drowsiness
Dizziness
Nausea
Sedation

Timeline

Rapid — clinical trials showed improvement within 3 days; full effect over the 14-day course.

FDA-approved August 2023. First oral fast-acting antidepressant with a novel mechanism. Taken for 14 days (not chronically like SSRIs). May be repeated if symptoms return. A major advance for both MDD and PPD.

LumateperoneBrand: CaplytaSchizophreniaBipolar Depression (both Bipolar I and II)

How it works

Simultaneously modulates serotonin, dopamine, and glutamate pathways — unique tri-modal mechanism with presynaptic dopamine partial agonism.

Common side effects

Somnolence
Dizziness
Nausea
Dry mouth

Timeline

Weeks for full antipsychotic/mood effect.

FDA-approved for bipolar depression in both Bipolar I and Bipolar II (rare among antipsychotics). Favorable metabolic profile. Once-daily dosing; can be taken with or without food.

VilazodoneBrand: ViibrydMajor Depressive DisorderGeneralized Anxiety Disorder

How it works

SSRI combined with partial agonism at the serotonin 5-HT1A receptor — a dual mechanism similar to combining an SSRI with buspirone.

Common side effects

Diarrhea
Nausea
Insomnia
Dry mouth

Timeline

4–6 weeks for full effect; GI side effects typically resolve after a few weeks.

Must be taken with food to ensure adequate absorption. The 5-HT1A partial agonist activity may contribute to fewer sexual side effects than standard SSRIs in some patients.

VortioxetineBrand: TrintellixMajor Depressive Disorder

How it works

Multimodal antidepressant — serotonin reuptake inhibitor plus direct agonist/antagonist activity at multiple serotonin receptor subtypes.

Common side effects

Nausea
Constipation or diarrhea
Dizziness
Sexual dysfunction (less than SSRIs)

Timeline

4–6 weeks for full antidepressant effect.

May improve cognitive symptoms of depression (concentration, memory) more than standard SSRIs. Generally well tolerated; nausea often resolves with continued use.

94 medications across 16 classes.

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