- •Table of Contents
- •If It Works 224
- •If It Works 234
- •If It Doesn’t Work 234
- •If It Doesn’t Work 274
- •If It Works 246
- •If It Doesn’t Work 246
- •If It Works 260
- •If It Doesn’t Work 261
- •If It Works 274
- •If It Works 315
- •If It Doesn’t Work 316
- •If It Works 330
- •If It Doesn’t Work 330
- •If It Works 339
- •If It Doesn’t Work 340
- •If It Works 351
- •If It Doesn’t Work 351
- •If It Works 361
- •If It Doesn’t Work 362
- •If It Works 369
- •If It Doesn’t Work 369
- •If It Works 378
- •If It Doesn’t Work 378
- •If It Works 386
- •If It Doesn’t Work 386
- •If It Works 398
- •If It Doesn’t Work 399
- •If It Works 404
- •If It Doesn’t Work 405
- •If It Works 411
- •If It Works 423
- •If It Doesn’t Work 424
- •If It Works 433
- •If It Doesn’t Work 433
- •If It Works 445
- •If It Doesn’t Work 445
- •If It Works 457
- •If It Doesn’t Work 458
- •If It Works 472
- •If It Doesn’t Work 472
- •If It Works 483
- •If It Doesn’t Work 483
- •If It Works 493
- •If It Doesn’t Work 494
- •If It Works 503
- •If It Doesn’t Work 504
- •If It Works 517
- •If It Doesn’t Work 518
- •If It Works 530
- •If It Doesn’t Work 530
- •If It Works 544
- •If It Doesn’t Work 544
- •If It Works 556
- •If It Doesn’t Work 557
- •If It Works 564
- •If It Doesn’t Work 564
- •If It Works 580
- •If It Doesn’t Work 580
- •If It Works 587
- •If It Doesn’t Work 587
- •If It Works 597
- •If It Doesn’t Work 597
- •If It Works 611
- •If It Doesn’t Work 612
- •If It Works 627
- •If It Doesn’t Work 628
- •If It Works 641
- •If It Doesn’t Work 641
- •If It Works 652
- •If It Doesn’t Work 652
- •If It Works 659
- •If It Doesn’t Work 660
- •If It Works 667
- •If It Doesn’t Work 668
- •If It Works 674
- •If It Doesn’t Work 674
- •If It Works 683
- •If It Doesn’t Work 683
- •If It Works 696
- •If It Doesn’t Work 697
- •If It Works 706
- •If It Doesn’t Work 707
- •If It Works 718
- •If It Doesn’t Work 719
- •If It Works 726
- •If It Doesn’t Work 726
- •If It Works 740
- •If It Works 752
- •If It Doesn’t Work 752
- •If It Works 762
- •If It Doesn’t Work 762
- •If It Works 770
- •If It Doesn’t Work 770
- •If It Works 783
- •If It Doesn’t Work 783
- •If It Works 790
- •If It Doesn’t Work 790
- •If It Doesn’t Work 803
- •If It Works 815
- •If It Doesn’t Work 816
- •If It Works 830
- •If It Doesn’t Work 830
- •If It Works 802
- •If It Works 839
- •If It Works 855
- •If It Works 863
- •If It Doesn’t Work 863
- •If It Works 886
- •If It Doesn’t Work 886
- •If It Works 899
- •If It Doesn’t Work 900
- •If It Works 912
- •If It Doesn’t Work 913
- •If It Works 923
- •If It Doesn’t Work 923
- •If It Works 933
- •If It Doesn’t Work 933
- •If It Works 939
- •If It Doesn’t Work 940
- •If It Works 953
- •If It Doesn’t Work 954
- •If It Works 967
- •If It Doesn’t Work 967
- •If It Works 980
- •If It Doesn’t Work 981
- •If It Works 987
- •If It Doesn’t Work 987
- •If It Works 998
- •If It Doesn’t Work 998
- •If It Works 1033
- •If It Doesn’t Work 1033
- •If It Works 1041
- •If It Doesn’t Work 1041
- •If It Works 1048
- •If It Doesn’t Work 1048
- •If It Works 1061
- •If It Doesn’t Work 1061
- •If It Works 1072
- •If It Doesn’t Work 1072
- •If It Works 1085
- •If It Doesn’t Work 1085
- •If It Works 1094
- •If It Doesn’t Work 1095
- •If It Works 1103
- •If It Doesn’t Work 1103
- •If It Works 1110
- •If It Doesn’t Work 1110
- •If It Works 1118
- •If It Doesn’t Work 1119
- •If It Works 1130
- •If It Doesn’t Work 1130
- •If It Works 1144
- •If It Doesn’t Work 1145
- •If It Works 1159
- •If It Doesn’t Work 1160
- •If It Works 1169
- •If It Works 1180
- •If It Doesn’t Work 1180
- •If It Works 1195
- •If It Doesn’t Work 1195
- •If It Works 1209
- •If It Doesn’t Work 1210
- •If It Works 1218
- •If It Doesn’t Work 1219
- •If It Works 1230
- •If It Doesn’t Work 1230
- •If It Works 1244
- •If It Doesn’t Work 1244
- •If It Works 1252
- •If It Doesn’t Work 1253
- •If It Works 1262
- •If It Doesn’t Work 1263
- •If It Works 1272
- •If It Doesn’t Work 1272
- •If It Works 1279
- •If It Works 1288
- •If It Doesn’t Work 1288
- •If It Works 1297
- •If It Doesn’t Work 1297
- •If It Works 1309
- •If It Doesn’t Work 1309
- •If It Works 1317
- •If It Doesn’t Work 1318
- •If It Works 1331
- •If It Doesn’t Work 1331
- •If It Works 1339
- •If It Doesn’t Work 1339
- •If It Works 1349
- •If It Doesn’t Work 1350
- •If It Works 1366
- •If It Doesn’t Work 1366
- •If It Works 1377
- •If It Doesn’t Work 1378
- •If It Works 1396
- •If It Doesn’t Work 1396
- •If It Works 1406
- •If It Doesn’t Work 1406
- •If It Works 1420
- •If It Doesn’t Work 1421
- •If It Works 1428
- •If It Doesn’t Work 1429
- •If It Works 1438
- •If It Doesn’t Work 1438
- •If It Works 1445
- •If It Doesn’t Work 1445
- •If It Works 1456
- •If It Doesn’t Work 1457
- •If It Works 1466
- •If It Works 1476
- •If It Doesn’t Work 1476
- •If It Works 1483
- •If It Works 1494
- •If It Doesn’t Work 1494
- •If It Works 1507
- •If It Doesn’t Work 1507
- •If It Works 1517
- •If It Doesn’t Work 1517
- •If It Works 1525
- •If It Doesn’t Work 1526
- •If It Works 1535
- •If It Doesn’t Work 1535
- •If It Works 1551
- •If It Doesn’t Work 1552
- •If It Works 1565
- •If It Works 1578
- •If It Doesn’t Work 1579
- •If It Works 1586
- •If It Doesn’t Work 1586
- •If It Works 1600
- •If It Doesn’t Work 1600
- •If It Works 1612
- •If It Doesn’t Work 1613
- •If It Works 1623
- •If It Doesn’t Work 1623
- •If It Works 1631
- •If It Doesn’t Work 1632
- •If It Works 1646
- •If It Doesn’t Work 1646
- •If It Works 1655
- •If It Works 1662
- •If It Doesn’t Work 1662
- •If It Works 1670
- •If It Doesn’t Work 1670
- •If It Works 1680
- •If It Doesn’t Work 1681
- •Prescriber’s Guide
- •Stahl’s Essential Psychopharmacology Prescriber’s Guide
- •Contents
- •Introduction
- •Introduction
- •List of icons
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Amisulpride
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works (for adhd)
- •If It Doesn’t Work (for adhd)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Pregnancy
- •How Long Until It Works
- •If It Works (for adhd)
- •If It Doesn’t Work (for adhd)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Drug Interactions
- •Other Warnings/Precautions
- •Pregnancy
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Aripiprazole: side effects How Drug Causes Side Effects
- •Dosing Tips – Oral
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Aripiprazole
- •How the Drug Works
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting an a typical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Asenapine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Life-Threatening or Dangerous Side Effects
- •Dosing Tips
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Asenapine
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Atomoxetine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Dosing Tips
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting any atypical antipsychotic
- •Monitoring after starting any atypical antipsychotic
- •Dosing Tips
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Bupropion: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Life-Threatening or Dangerous Side Effects
- •Dosing Tips
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work (for bipolar disorder)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Drug Interactions
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •Pregnancy
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Chlorpromazine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Citalopram: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Clozapine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Life-Threatening or Dangerous Side Effects
- •Weight Gain
- •Sedation
- •What to Do About Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Clozapine
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Cyamemazine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Desipramine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Life-Threatening or Dangerous Side Effects
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Desvenlafaxine: side effects How Drug Causes Side Effects
- •Overdose
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •Other Warnings/Precautions
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Doxepin: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Life-Threatening or Dangerous Side Effects
- •Dosing Tips
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Duloxetine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Escitalopram: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Fluoxetine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Flupenthixol: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Fluphenazine: side effects How Drug Causes Side Effects
- •Dosing Tips – Oral
- •Dosing Tips – Depot
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Fluvoxamine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Dosing Tips
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work (for neuropathic pain or bipolar disorder)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Gabapentin: special populations Renal Impairment
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Haloperidol: side effects How Drug Causes Side Effects
- •Dosing Tips – Oral
- •Dosing Tips – Depot
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Iloperidone
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •Other Warnings/Precautions
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work (for bipolar disorder)
- •Best Augmenting Combos for Partial Response or Treatment Resistance (for bipolar disorder)
- •Weight Gain
- •Sedation
- •What to Do About Side Effects
- •Best Augmenting Agents for Side Effects
- •Lamotrigine: dosing and use Usual Dosage Range
- •Dosage Forms
- •How to Dose
- •Dosing Tips
- •Drug Interactions
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work (for bipolar disorder or neuropathic pain)
- •Levetiracetam: special populations Renal Impairment
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Levomilnacipran: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works (for adhd)
- •If It Doesn’t Work (for adhd)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •Lisdexamfetamine: the art of psychopharmacology Potential Advantages
- •Potential Disadvantages
- •Primary Target Symptoms
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Loxapine: side effects How Drug Causes Side Effects
- •Dosing Tips
- •Drug Interactions
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting any atypical antipsychotic
- •Monitoring after starting any atypical antipsychotic
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Lurasidone
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •Mesoridazine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works (for adhd)
- •If It Doesn’t Work (for adhd)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Other Warnings/Precautions
- •Pregnancy
- •How Long Until It Works
- •If It Works (for adhd)
- •If It Doesn’t Work (for adhd)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •How to Dose
- •Dosing Tips
- •Other Warnings/Precautions
- •Pregnancy
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Milnacipran: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Moclobemide: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How the Drug Works
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Molindone: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Other Warnings/Precautions
- •Dosing Tips
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Nefazodone: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Olanzapine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Dosing Tips – Oral
- •Dosing Tips – Depot
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Oral Olanzapine
- •Switching from Oral Antipsychotics to Olanzapine lai
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •Dosing Tips
- •Drug Interactions
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting an atypical antipsychotic:
- •Monitoring after starting an atypical antipsychotic:
- •Paliperidone: side effects How Drug Causes Side Effects
- •Dosing Tips – Oral
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Paliperidone er
- •Switching from Oral Antipsychotics to Paliperidone Palmitate
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Paroxetine: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Dosing Tips
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Perphenazine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Phenelzine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •Other Warnings/Precautions
- •Pimozide: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Pipothiazine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work (for neuropathic pain)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Pregabalin: special populations Renal Impairment
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Protriptyline: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Life-Threatening or Dangerous Side Effects
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Quetiapine: side effects How Drug Causes Side Effects
- •Dosing Tips
- •Children and Adolescents
- •Pregnancy
- •Switching from Oral Antipsychotics to Quetiapine
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How the Drug Works
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Risperidone: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Dosing Tips – Oral Formulation
- •Dosing Tips – Long-Acting Microsphere Depot Formulation
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •Risperidone: the art of psychopharmacology Potential Advantages
- •Potential Disadvantages
- •Primary Target Symptoms
- •Switching from Oral Antipsychotics to Risperidone
- •Switching from Oral Antipsychotics to Risperidone lai
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Selegiline: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Life-Threatening or Dangerous Side Effects
- •Drug Interactions
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Sertraline: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Dosing Tips
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •Sertraline: the art of psychopharmacology Potential Advantages
- •Potential Disadvantages
- •Primary Target Symptoms
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Sulpiride: side effects How Drug Causes Side Effects
- •Children and Adolescents
- •Pregnancy
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •Thioridazine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Thiothixene: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •If It Doesn’t Work (for neuropathic pain or anxiety disorders)
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Pregnancy
- •Breast Feeding
- •Dosing Tips
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Dosing Tips
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Trifluoperazine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •If It Doesn’t Work (for depression)
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •Best Augmenting Combos for Partial Response or Treatment Resistance (for bipolar disorder)
- •How to Dose
- •Dosing Tips
- •Other Warnings/Precautions
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Venlafaxine: side effects How Drug Causes Side Effects
- •Pharmacokinetics
- •Drug Interactions
- •Other Warnings/Precautions
- •Elderly
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Vilazodone: side effects How Drug Causes Side Effects
- •Notable Side Effects
- •Other Warnings/Precautions
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Vortioxetine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Pregnancy
- •Breast Feeding
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Tests Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Ziprasidone: side effects How Drug Causes Side Effects
- •Dosing Tips
- •Children and Adolescents
- •Pregnancy
- •Breast Feeding
- •Ziprasidone: the art of psychopharmacology Potential Advantages
- •Potential Disadvantages
- •Primary Target Symptoms
- •Switching from Oral Antipsychotics to Ziprasidone
- •Dosing Tips
- •Other Warnings/Precautions
- •How Long Until It Works
- •If It Works
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Before starting an atypical antipsychotic
- •Monitoring after starting an atypical antipsychotic
- •Zotepine: side effects How Drug Causes Side Effects
- •Other Warnings/Precautions
- •Elderly
- •If It Doesn’t Work
- •Best Augmenting Combos for Partial Response or Treatment Resistance
- •Zuclopenthixol: side effects How Drug Causes Side Effects
- •Dosing Tips
- •Other Warnings/Precautions
- •Children and Adolescents
- •Pregnancy
- •Index by Drug Name
- •Index by Use
- •Valproate (divalproex) 711
- •Valproate (divalproex) 711
- •Valproate (divalproex) 711
- •Index by Class
- •Abbreviations
List of icons
alcohol
dependence treatment
alpha
adrenergic blocker
alpha
2 agonist
anticonvulsant
antihistamine
antiparkinson/anticholinergic
benzodiazepine
beta
blocker
cholinesterase
inhibitor
conventional
antipsychotic
dopamine
stabilizer
lithium
lorcaserin
medical
food
l-methylfolate
monoamine
oxidase inhibitor
nefazodone
(serotonin antagonist/reuptake inhibitor)
nicotinic
partial agonist
N-methyl-D-aspartate
antagonist
noradrenergic
and specific serotonergic antidepressant
norepinephrine
and dopamine reuptake inhibitor
sedative-hypnotic
selective
norepinephrine reuptake inhibitor
selective
serotonin reuptake inhibitor
serotonin-dopamine
antagonist
serotonin
and norepinephrine reuptake inhibitor
serotonin
1A partial agonist
serotonin
partial agonist reuptake inhibitor
sodium
oxybate
thyroid
hormone
topiramate/phentermine
trazodone
(serotonin antagonist/reuptake inhibitor)
tricyclic/tetracyclic
antidepressant
vortioxetine
How
the drug works, mechanism of action
Best
augmenting agents to add for partial response or treatment-resistance
Life-threatening
or dangerous side effects
Weight
Gain: Degrees of weight gain associated with the drug, with
unusual signifying that weight gain has been reported but is not
expected; not unusual signifying that weight gain occurs in a
significant minority; common signifying that many experience weight
gain and/or it can be significant in amount; and problematic
signifying that weight gain occurs frequently, can be significant in
amount, and may be a health problem in some patients
Sedation: Degrees of sedation associated with the drug, with unusual signifying that sedation has been reported but is not expected; not unusual signifying that sedation occurs in a significant minority; common signifying that many experience sedation and/or it can be significant in amount; and problematic signifying that sedation occurs frequently, can be significant in amount, and may be a health problem in some patients
Tips
for dosing based on the clinical expertise of the author
Warnings
and precautions regarding use of the drug
Dosing
and other information specific to children and adolescents
Information
regarding use of the drug during pregnancy
Clinical
pearls of information based on the clinical expertise of the author
The
art of switching
Suggested
reading
ACAMPROSATE
ACAMPROSATE: THERAPEUTICS
Brands
• Campral
see index for additional brand names
Generic?
Not in U.S.
Class
• Alcohol dependence treatment
Commonly Prescribed for
(bold for FDA approved)
• Maintenance of alcohol abstinence
How the Drug Works
• Theoretically reduces excitatory glutamate neurotransmission and increases inhibitory gamma-aminobutyric acid (GABA) neurotransmission
• Binds to and blocks certain glutamate receptors, including metabotropic glutamate receptors
• Because withdrawal of alcohol following chronic administration can lead to excessive glutamate activity and deficient GABA activity, acamprosate can act as “artificial alcohol” to mitigate these effects
How Long Until It Works
• Has demonstrated efficacy in trials lasting between 13 and 52 weeks
If It Works
• Increases abstinence from alcohol
If It Doesn’t Work
• Evaluate for and address contributing factors
• Consider switching to another agent
• Consider augmenting with naltrexone
Best Augmenting Combos for Partial Response or Treatment Resistance
• Naltrexone
• Augmentation therapy may be more effective than monotherapy
• Augmentation with behavioral, educational, and/or supportive therapy in groups or as an individual is probably key to successful treatment
Tests
• None for healthy individuals
ACAMPROSATE: SIDE EFFECTS
How Drug Causes Side Effects
• Theoretically, behavioral side effects due to changes in neurotransmitter concentrations at receptors in parts of the brain and body other than those that cause therapeutic actions
• Gastrointestinal side effects may be related to large doses of a drug that is an amino acid derivative, increasing osmotic absorption in the GI tract
Notable Side Effects
• Diarrhea, nausea
• Anxiety, depression
Life-Threatening or Dangerous Side Effects
• Suicidal ideation and behavior (suicidality)
Weight Gain
• Reported but not expected
Sedation
• Reported but not expected
What to Do About Side Effects
• Wait
• Adjust dose
• If side effects persist, discontinue use
Best Augmenting Agents for Side Effects
• Dose reduction or switching to another agent may be more effective since most side effects cannot be improved with an augmenting agent
ACAMPROSATE: DOSING AND USE
Usual Dosage Range
• 666 mg three times daily (>60 kg)
• 666 mg two times daily (<60 kg)
Dosage Forms
• Tablet 333 mg
How to Dose
• Patient should begin treatment as soon as possible after achieving abstinence
• Recommended dose is 666 mg three times daily; titration is not required
Dosing Tips
• Providing educational materials and counseling in combination with acamprosate treatment can increase the chances of success
• Patients should be advised to continue treatment even if relapse occurs and to disclose any renewed drinking
• Although absorption of acamprosate is not affected by food, it may aid adherence if patients who regularly eat three meals per day take each dose with a meal
• Adherence with three times daily dosing can be a problem; having patient focus on frequent oral dosing of drug rather than frequent drinking may be helpful in some patients
Overdose
• Limited available data; diarrhea
Long-Term Use
• Has been studied in trials up to one year
Habit Forming
• No
How to Stop
• Taper not necessary
Pharmacokinetics
• Terminal half-life 20–33 hours
• Excreted unchanged via the kidneys
Drug Interactions
• Does not inhibit hepatic enzymes, and thus is unlikely to affect plasma concentrations of drugs metabolized by those enzymes
• Is not hepatically metabolized and thus is unlikely to be affected by drugs that induce or inhibit hepatic enzymes
• Concomitant administration with naltrexone may increase plasma levels of acamprosate, but this does not appear to be clinically significant and dose adjustment is not recommended
Other Warnings/Precautions
• Monitor patients for emergence of depressed mood or suicidal ideation and behavior (suicidality)
• Use cautiously in individuals with known psychiatric illness
Do Not Use
• If patient has severe renal impairment
• If there is a proven allergy to acamprosate
ACAMPROSATE: SPECIAL POPULATIONS
Renal Impairment
• For moderate impairment, recommended dose is 333 mg three times daily
• Contraindicated in severe impairment
Hepatic Impairment
• Dose adjustment not generally necessary
Cardiac Impairment
• Limited data available
Elderly
• Some patients may tolerate lower doses better
• Consider monitoring renal function
Children and Adolescents
• Safety and efficacy have not been established
Pregnancy
• Risk Category C [some animal studies show adverse effects; no controlled studies in humans]
• Pregnant women needing to stop drinking may consider behavioral therapy before pharmacotherapy
• Not generally recommended for use during pregnancy, especially during first trimester
Breast Feeding
• Unknown if acamprosate is secreted in human breast milk, but all psychotropics assumed to be secreted in breast milk
• Recommended either to discontinue drug or bottle feed
ACAMPROSATE: THE ART OF PSYCHOPHARMACOLOGY
Potential Advantages
• Individuals who have recently abstained from alcohol
• For the chronic daily drinker
Potential Disadvantages
• Individuals who are not abstinent at time of treatment initiation
• For binge drinkers
Primary Target Symptoms
• Alcohol dependence
Pearls
• Because acamprosate serves as “artificial alcohol,” it may be less effective in situations in which the individual has not yet abstained from alcohol or suffers a relapse
• Thus acamprosate may be a preferred treatment if the goal is complete abstinence, but may not be preferred if the goal is reduced-risk drinking
Suggested Reading
Anton RF, O’Malley SS, Ciraulo DA et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 2006;295(17):2003–17.
Kranzler HR, Gage A. Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials. Am J Addictions 2008; 17:70–6.
Rosner S, Leucht P, Soyka M. Acamprosate supports abstinence, naltrexone prevents excessive drinking: evidence from a met-analysis with unreported outcomes. J Psychopharmacol 2008;22:11–23.
AGOMELATINE
AGOMELATINE: THERAPEUTICS
Brands
• Valdoxan
see index for additional brand names
Generic?
No
Class
• Agonist at melatonergic 1 and melatonergic 2 receptors
• Antagonist at 5HT2C receptors
Commonly Prescribed for
(bold for FDA approved)
• Depression
• Generalized anxiety disorder
How the Drug Works
• Actions at both melatonergic and 5HT2C receptors may be synergistic and increase norepinephrine and dopamine neurotransmission in the prefrontal cortex; may resynchronize circadian rhythms that are disturbed in depression
• No influence on extracellular levels of serotonin
How Long Until It Works
• Daytime functioning, anhedonia, and sleep can improve from the first week of treatment
• Onset of full therapeutic actions in depression is usually not immediate, but often delayed 2–4 weeks
• May continue to work for many years to prevent relapse of symptoms
If It Works
• The goal of treatment is complete remission of current symptoms as well as prevention of future relapses
• Treatment most often reduces or even eliminates symptoms, but not a cure since symptoms can recur after medicine is stopped
• Continue treatment until all symptoms are gone (remission)
• Once symptoms gone, continue treating for 1 year for the first episode of depression
• For second and subsequent episodes of depression, treatment may need to be indefinite