Guides
Some questions about psychiatric medication do not belong to any single drug. How long until it works. Whether a side effect is normal. How to come off a medication without a rough landing. Whether to add therapy. These guides answer the questions that cut across every medication.
They are organized around the moments where most questions come up: starting a medication, managing side effects, switching, stopping, and finding a prescriber. Each guide is written in plain language and medically reviewed, the same standard as the medication guides.
Also here is a printable appointment sheet, a simple way to organize what you want to raise at your next visit. If your question is about one specific medication, the medication guides cover it in depth. If it is broader than that, it is probably answered here.
Antidepressants and sexual side effects
How common sexual side effects are, why they happen, and what can be done about them.
Antidepressants and weight
What antidepressants tend to do to weight, which ones differ, and how to think about it.
Antidepressants for elderly patients, ranked
Which antidepressants are best for older adults, and which to avoid. Sertraline, escitalopram, and mirtazapine are usually first-line. Paroxetine and TCAs are usually avoided (Beers Criteria). Special considerations for hyponatremia, falls, drug interactions, and dementia.
Antidepressants safest in pregnancy, ranked by evidence
Which antidepressants have the best pregnancy safety data, which have concerning signals, and how to weigh treatment against untreated maternal depression. Sertraline is first-line for most patients; paroxetine has FDA warnings; MAOIs and specific SNRIs need caution.
Antidepressants with the lowest sexual side effects
Bupropion, mirtazapine, vortioxetine, vilazodone, and trazodone have the lowest rates of sexual dysfunction among antidepressants. Which drug to choose when preserving sexual function is a priority, and how the mechanisms differ.
Antidepressants with the lowest weight gain
Which antidepressants cause the least weight gain, and which cause the most. Bupropion is weight-neutral or causes weight loss. Mirtazapine causes the most among common antidepressants. Ranking and clinical decision framework.
Antipsychotic chlorpromazine equivalents
CPZ-equivalent doses for typical and atypical antipsychotics, WHO defined daily doses, and how to use them for cross-tapers and dose reviews.
Antipsychotics for elderly patients
Antipsychotics in older adults carry stroke and mortality warnings and require careful selection. Quetiapine and risperidone are most commonly used at low doses. Cobenfy and aripiprazole are lower-risk options. Boxed warning framing and non-drug alternatives first.
Antipsychotics with the lowest EPS risk
Which antipsychotics cause the least extrapyramidal symptoms (EPS): akathisia, parkinsonism, dystonia, tardive dyskinesia. Clozapine, quetiapine, and the newest drugs (Cobenfy, lumateperone) rank lowest.
Beers Criteria: psychiatric medications in older adults
The 2023 Beers Criteria list of psychiatric medications to avoid or use with caution in adults 65 and older, why, and safer alternatives.
Benzodiazepine equivalents
Diazepam-equivalent doses, half-lives, and onset for common benzodiazepines. The table for cross-tapers, inpatient conversions, and alcohol withdrawal protocols.
Benzodiazepines ranked by half-life
Every benzodiazepine used in psychiatry ranked by half-life, from ultra-short-acting midazolam to long-acting diazepam and clonazepam. Half-life determines onset, duration, withdrawal difficulty, and clinical use case.
Coming off an antidepressant safely
What discontinuation feels like, and how a careful taper makes stopping manageable.
Comorbidity-based medication selection in psychiatry
How specific comorbidities tip the choice: depression plus insomnia, depression plus sexual dysfunction concern, depression plus weight, depression plus anxiety, MDD plus ADHD, bipolar plus anxiety, psychosis plus PTSD.
CYP450 interactions in psychiatric prescribing
Substrate, inhibitor, and inducer status for every common psychiatric medication, organized by CYP enzyme, with the interactions that actually change clinical decisions.
Discontinuation syndromes in psychiatric medications
Recognition and management of SSRI/SNRI discontinuation, benzodiazepine withdrawal, stimulant hold, antipsychotic withdrawal dyskinesia, and lithium rebound.
Generic vs brand-name psychiatric medication
Whether generic psychiatric medications are as good as the brand, and what to know.
Hepatic dosing for psychiatric medications
Which psychiatric meds are LFT-friendly, which need dose reduction by Child-Pugh class, and which to avoid outright in liver disease.
How to get psychiatric medication management
Who can prescribe psychiatric medication, the in-person and telepsychiatry options, and how to choose.
Long-acting injectable antipsychotics (LAIs) compared
Every FDA-approved long-acting injectable antipsychotic compared: dose interval, initiation loading, oral coverage, price, and where each fits. Aripiprazole, paliperidone, risperidone, olanzapine, haloperidol, fluphenazine LAIs plus 3-month and 6-month options.
Medication, therapy, or both
What the evidence says about medication, therapy, and combining them.
Medications for ADHD
What stimulants and non-stimulants are used for ADHD, when to pick which, and what the cardiac and growth monitoring picture looks like.
Medications for Alzheimer's
What medications are used across mild, moderate, and severe Alzheimer's, where the anti-amyloid antibodies fit, and how to handle agitation.
Medications for anxiety
What medications are used for generalized anxiety, panic, and social anxiety, and where benzodiazepines fit and where they don't.
Medications for bipolar disorder
What medications are used across mania, bipolar depression, and maintenance, and where the pitfalls sit.
Medications for depression
What medications are used for depression, how prescribers pick among them, and what to do when the first one doesn't work.
Medications for insomnia
What sleep medications are used, where the newer orexin antagonists fit, and why CBT-I is still first-line.
Medications for OCD
What medications are used for OCD, why the doses run higher than in depression, and where clomipramine and augmentation fit.
Medications for opioid use disorder
What medications are used for opioid use disorder, how buprenorphine, methadone, and naltrexone compare, and where overdose reversal fits.
Medications for PTSD
What medications are used for PTSD, where prazosin fits for nightmares, and why benzodiazepines are usually avoided.
Medications for schizophrenia
What antipsychotics are used for schizophrenia, where clozapine and LAIs fit, and how metabolic monitoring changes the picture.
Mood stabilizers ranked for bipolar disorder
Lithium, valproate, lamotrigine, and second-generation antipsychotics as mood stabilizers. Which to use for acute mania vs depression vs maintenance, side effect trade-offs, and evidence base for each.
Most sedating antipsychotics, ranked
Which antipsychotics cause the most sedation, ranked from most to least sedating, with mechanism (H1, alpha-1, muscarinic), typical dose relationship, and when sedation is desired vs unwanted.
Non-stimulant ADHD medications ranked
The four main non-stimulant ADHD medications compared: atomoxetine, viloxazine (Qelbree), guanfacine ER, clonidine ER (including Onyda XR). Efficacy, side effect profiles, and when to choose each.
Over-the-counter and natural sleep aids: what the evidence shows
An honest look at antihistamines, melatonin, valerian, chamomile, and magnesium for sleep.
Psychiatric medication and alcohol
How alcohol interacts with antidepressants and other psychiatric medications, and why caution makes sense.
Psychiatric medication half-life quick reference
Half-lives across SSRIs, SNRIs, antipsychotics, benzodiazepines, mood stabilizers, and stimulants, with what that means for taper speed, discontinuation risk, and switching.
Psychiatric medication in pregnancy and breastfeeding
How decisions about psychiatric medication in pregnancy and breastfeeding are approached.
Psychiatric medication in pregnancy and lactation
A working framework for pregnancy and breastfeeding decisions across antidepressants, mood stabilizers, antipsychotics, benzodiazepines, and stimulants, with LactMed pointers.
Questions for my appointment
A printable sheet to organize what you want to cover with your prescriber.
Renal dosing for psychiatric medications
Which psychiatric meds to avoid, dose-adjust, or feel safe with by eGFR band. Lithium first, then everything else.
Sleep medications ranked
Every prescription sleep medication compared: Z-drugs, benzodiazepines, DORAs (Belsomra, Dayvigo, Quviviq), doxepin, ramelteon, mirtazapine, trazodone. Which to choose for sleep initiation vs maintenance, safety in older adults, and dependence risk.
Starting a psychiatric medication: what the first month is like
A realistic week-by-week picture of beginning an antidepressant, and what is normal.
Switching antidepressants
Why people switch antidepressants, how a switch is done, and what to expect.
Switching antidepressants: cross-taper and washout matrix
Direct-switch, cross-taper, and MAOI washout rules for switching antidepressants, with the meds (fluoxetine, paroxetine, venlafaxine) that need special handling.
Switching antipsychotics
Cross-taper, plateau, and abrupt-switch strategies for antipsychotic changes, with attention to withdrawal dyskinesia, rebound psychosis, and metabolic switch considerations.
Why isn't my medication working?
Common reasons an antidepressant doesn't seem to be helping, and what usually comes next.