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Psychiatric Medication Guide

The document provides medication options for various mental health conditions including depression, anxiety, bipolar disorder, PTSD, and schizophrenia. For depression, recommended first-line medications include SSRIs like Zoloft and Prozac. For treatment-resistant depression, newer medications like Viibryd and Fetzima are options. For bipolar disorder, lithium, Seroquel, Lamictal, and Abilify are recommended as monotherapy or in combination depending on the specific diagnosis and symptoms. Common medications for anxiety include hydroxyzine, buspirin, and venlafaxine. The document also lists medication recommendations for conditions like ADHD, insomnia, OCD, and others.

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MaryNguyen
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58 views3 pages

Psychiatric Medication Guide

The document provides medication options for various mental health conditions including depression, anxiety, bipolar disorder, PTSD, and schizophrenia. For depression, recommended first-line medications include SSRIs like Zoloft and Prozac. For treatment-resistant depression, newer medications like Viibryd and Fetzima are options. For bipolar disorder, lithium, Seroquel, Lamictal, and Abilify are recommended as monotherapy or in combination depending on the specific diagnosis and symptoms. Common medications for anxiety include hydroxyzine, buspirin, and venlafaxine. The document also lists medication recommendations for conditions like ADHD, insomnia, OCD, and others.

Uploaded by

MaryNguyen
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Medication Choices:

Depression – SSRIs, zoloft, prozac, abilify (*max dose 10-15mg when adding
to SSRI), lithium, (*paxil*)

If tried/failed several SSRI/SNRI can try some of the newer ones as below:
Depression w/anxiety- can try Viibryd (vilazodone) no weight gain or sexual
side effects, can help with IBS

Depression w/pain- Fetzima (levomilnacipran) SNRI, can improve pain and


social function, can increase BP and HR, no weight effects sometimes ED

Depression in elderly or w/ cognitive deficits: Trintellix (vortioxetine)


Careful adding this to Wellbutrin, no significant weight gain or sexual
side effects noted

SI/severe depression- Abilify add-on, if Abilify naïve start at 2mg and can go
up Q 7-10 days

Anxiety – (Vistaril) hydroxyzine paomate, buspar, venlafaxine, beta blocker,


neurontin, OTC inositol 500mg (up to 4,000mg BID for adults and up to
2,000mg BID for kids/teens) (*benzo*)

Bipolar I d/o: monotherapy with lithium, seroquel, olanzapine, lamictal (to


prevent depression), and Abilify (to prevent mania).

Lithium has the best evidence for prevention of mania or hypomania


Lamictal superior to lithium in preventing depressive episodes

* For those with recent or severe mania, Lamictal should only be used in
combination with lithium, olanzapine, or abilify (2.5mg go up Q 2 weeks).

Bipolar II d/o: Seroquel first line for acute depression


Second line: lithium, Lamictal, or Depakote, or combination of lithium and
Depakote.

SSRI + lithium/Depakote/or atypical but avoid SSRI if 2 or more of agitation


or rapid cycling present
Picking behaviors: high dose SSRI (zoloft, Prozac, luvox) and can augment
with atypical or perphenazine

Anger/Aggression- add Lamictal (Tegretol if TBI patient)

Sleep – trazodone, melatonin, inositol, gabacalm, rozerem, clonidine

ADHD – start on short-acting (Ritalin, Adderall) then switch to concerta


- Attention – concerta
- Hyperactive – clonidine, tenex

Night Terrors – prazosin, cyproheptadine (start at 4mg qhs and go up by 4mg


every 4-7 nights until effective, NTE 32mg/day)

OCD – SSRIs - luvox

Mood Stabilizing – lithium, Depakote, lamictal, (*tegretol*), atypical


antipsychotics

PTSD – SSRIs, clonidine, propranolol, mirtazapine, Pristiq

Phobic d/o – beta blockers, SSRIs, gabapentin

Schizophrenia – Geodon, Risperdal, zyprexa, seroquel, abilify, haldol,


(*clozaril*)
Fanapt: weight neutral (4-5#/year), almost no AIMs, only FDA approved
for schizophrenia but in a couple of years should be FDA approved for
bipolar/schizoaffective, PTSD with nightmares, and injectable someday too
Vraylar: high rate of AIMs possible, weight neutral (~5#/year), FDA
approved for Bipolar and schizophrenia

EPS symptoms assoc. w/ atypical antipsychotic use-


Cogentin 1mg bid prn restlessness (can use up to 6mg/day)
Or Artane (trihexylphenidyl) 1-2 mg bid prn restlessness

Alcohol Dependence – naltrexone, acamprosate


**Pregnancy** - NO paxil and NO depakote – fluoxetine is good
Latuda OK (is category B all others category C)

Breastfeeding- Zoloft is medication of choice, Paxil


*If patient was on Prozac/Celexa during pregnancy and were
effective and stable can continue these in breastfeeding as long as you
discuss with patient that COULD get in breast milk

KIDS: (lovaza 1,000 mg BID, multivitamin with minerals, zinc 30mg,


magnesium citrate/glycenate 300mg is good for the brain)

Anxiety: use SSRI (Prozac most forgiving at this age)


Prozac: Start at 10mg and titrate up
Zoloft: Start at 25mg and titrate up to at least 100mg if > 10 years old
*can also try low dose Neurontin
* make sure SLEEP is good (melatonin, then clonidine, trazodone last)

Activated kids: Tenex up to TID, if not working then try Intuniv, then try
Lamictal, then Trileptal, then atypical (Risperidone, Aripiperazole) if very
aggressive/violent

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