Serotonin mood, libido, pain, sleep, appetite, temperature

Dopamine pleasure, movement, addiction, learning, memory,

AH/VH, psychosis
Acetylcholine muscle contraction, memory, learning
Neurotransmitters

GABA inhibitory, calming (low in anxiety)

Glutamate excitatory, memory (low in insomnia and low energy
and alzheimers)
Norepinephrine fight, flight, freeze (low in ADHD and MDD)

Depression: 1st line 2nd line 3rd line

citalopram (Celexa) prolonged QTc
escitalopram (Lexapro) purified form of celexa (dble strength), prolong QTc
Fluoxetine (Prozac) Long half life
SSRIs (HA, GI,
increase SI, wt. gain) fluvoxamine (Luvox) OCD
Paroxetine (Paxil) Short half life, no for prego (cardiac)
sertraline (Zoloft) Increased GI sx
vilazodone (Viibryd) helpful with comorbid GAD
desvenlafaxine (Pristiq) Watch BP
SNRIs (HA, GI, BP duloxetine (Cymbalta) pain
increase SI) levomilnacipran (Fetzima) increases concentration, motivation
venlafaxine (Effexor) increased BP, short 1/2 life, slow taper
NDRI (GI, seizure, can increase anxiety; good for tobacco and adhd,
HTN) buproprion (Wellbutrin) don't use w/ eating disorder
amitriptyline (Elavil) pain
TCAs- increase 5HT
and NE clomipramine (Anafranil) gold standard OCD
(anticholingergic, imapramine enuresis
toxic in OD, mirtazapine (Remeron) sedation, wt gain
analgesic, wide QRS)
nortriptyline (Pamelor) less sedation and ACH (good for elderly); pain
MAOIs (increase
5HT, NE, D2)- best isocarboxazid (Marplan)
for atypical MDD. No phenelzine (Nardil)
tryamine (HTN crisis) selegiline (Ensam) also treats Parkinsons
*2 wk wash out (HA,
GI, insomnia) tranylcypromine (Parnate)
trazodone (Desyrel) 5HT modulator. (sedation, GI, pripaism)
Other vortioxetine (Trintellix) 5HT multimodal, increases. (GI, dry, dizzy)
agomelatine (Valdoxan) increases melatonin, regulates sleep, liver enzymes
ADJUNCT- 1st line abilify, seroquel, risperdal
ADJUNCT- 2nd line wellblutrin, Li, remeron, provigil, T3, zyprexa

ADJUNCT- 3rd line other AD, stimulant, TCA, geodon

MDD w/psychosis AP (usually FGA) + AD
MDD w/ insomnia remeron, seroquel, trazodone
MDD w/ fatigue wellbutrin, SSRI
PDD sertraline, SSRI, buproprion, MAOI, imipramine, mirtazapine
MDD in elderly SSRI, SNRI (watch BP), wellbutrin, effexor, mirtazapine, pamelor
MDD in kids fluoxetine, escitalopram, sertraline
Seasonal affect sertraline, citalopram, escitalopram, partoxetine, fluoxetine, buproprion
 ETOH Abuse:
chlordiazepoxide (Libirum) Naltrexone(Revia,vivitrol)- Acomprosate ((Campral)
diazepam (Valium) opiod antagonist Disulfiram (Antabuse)

ODD/Impulse/aggression:
chlorpromazine Guanfacine (Tenex,
(Thorazine) Intuniv) Methylphenidate
Clonidine (Kapvay) Risperdone Atomoxetine

Anxiety: 1st line 2nd line 3rd line

midazolam (Versed) short-acting
Anxiolytics (increase GABA lorazepam (Ativan) intermediate-acting
freq)- tolerance, effects on clonazepam (Klonipin) intermediate-acting
memory & cognition (esp
in elderly), increase alprazolam (Xanax) intermediate-acting
anxiety and MDD longterm diazepam (Valium) long-acting
chlordiazepoxide (Librium) long-acting
Antidepressants SSRIs, SNRIs
propranolol (Inderal)
Blood pressure meds
prazosin (minipress) PTSD nitemares
gabapentin (Neurontin) off label for anxiety
hydroxyzine (Atarax, Vistirilantihistamine
Other
baclofen (Lioresal) muscle relaxant (usually for CP, MS)
busprione (Buspar) no sedation
pregabalin (Lyrica) nerve pain
duloxetine, escitalopram, paroxetine, pregabalin, sertraline,
GAD venlafaxine
busprione, imipramine, seroquel
citalopram, DVA, fluoxetine, mirtazapine, trazadone
escitalopram, fluvoxamine, paroxetine, pregabalin, sertraline,
Social Anx disorder venlafaxine
alprazolam, citalopram, gabapentin
clomipramine, DVA, duloxetine, fluoxetine, mirtazapine, olanazpine,
topiramate
fluoxetine, paroxetine, sertraline, venlafaxine
PTSD fluvoxetine, mirtazapine
abilify, buproprion, buspar, duloxetine, escitalopram, imipramine,
OCD lamictal, quetiapine,
fluvoxetine, risperidone,
fluoxetine, topiramate,
escitalopram, trazodone
paroxetine, sertraline,
clomipramine
Citalopram, fluoxetine, fluvoxetine, paroxetine, sertraline, venlafaxine,
Panic clomipramine, imipramine, buspirone, alprazolam, clonazepam,
lorazepam, dizaepam

Sleep/Insomnia
zoplicone (Zimovane) Sedating Antidepressants:mirtazipine, trazodone
zolpidem (Stilnoct) APs: Quetiapine
zaleplon (Sonata) Antihistamines: promethazine, hydroxyzine
Short-acting benzos suvorexant (Belsomra)
Long-acting benzos Promethazine (Phenergan) Melatonin (circadin PR)
(nitrazepam)
Long-acting benzos Promethazine (Phenergan) Melatonin (circadin PR)
(nitrazepam)
 Bipolar Disorder 1st line 2nd line 3rd line
Chlorpromazine
sedation, Mood stabilizers Lithium kidney, reduces SI, hypothyroid,
(Thorazine)
corneal Short- (Eskalith, teratogenic (Epstein's). Monitor
deposits acting IM Lithobid) createnine, TSH, Li, prego

fluphenazine Short- Valproic Acid increases GABA, level 80-120,

(Prolixin) acting IM LAI (Depakote) teratogenic (neural tube), liver

FGA APs-
decrease EPS, IV-
D2 (EPS) cardiac
monitor for
QTC
Haloperidol prolongatio Short- Anticonvulsants Lamotrigine
(Haldol) n acting IM LAI (increase GABA) (Lamictal) SJS

Perphenazine
(Trilafon) carbamazepine Level 8-12, also for pain, liver,
(Tegretol) neural tube defects, agranulo, SJS
topiramate
Pimozide (Orap) (Topamax) weight loss, decrease impulsivity
Aripiprazole Short- oxcarbazepine
(Abilify) ODT acting IM LAI (Trileptal) rare decrease in sodium
Li, Lamictal, VPA, olanzapine, quetiapine, ripserdal
Asenapine LAI, abilify. Combo: Li or DVA with seroquel,
(Saphris) sublingual risperdal
DVA. Li &LAI, abilify, geodonLi or DVA & Zyprexa. Li
carbamazepine.
Brexpiprazole BD I & risperdal. Li & Lamictal. Olanazapine &
(Rexulti) Mainenance: fluoxetine
asenapine
Cariprazine
(Vraylar)
Clozapine Li, lamictal, seroquel
SGA APs- (Clozaril) agranulocytosis, REMS
decrease Iloperidone BD II DVA, Li, DVA or SGA with AD or combo or Li, DVA,
D2, (Fanapt) ODT Maintenance: or SGA
increase
5HT Lurasidone
(metabolic (Latuda) Take with food carbamazepine, oxcarbazepine, SGA, fluoxetine
Ses)
Olanzapine Short- Li, DVA, zyprexa, risperdal, seroquel, abilify,
(Zyprexa) acting IM LAI geodon, asenapine, paliperidone
Paliperidone Mania:
(Invega) LAI carbamazepine, haldol. Combo Li & DVA
Quetiapine chlorpromazine, clozapine, oxcarbazepine,
(Seroquel) tamoxifen. Combo Li or DVA & Haldol
Risperidone Li, lamictal, seroquel. Combo Li or DVA with SSRI.
(Risperdal) ODT LAI Olanzapine + SSRI. Li + DVA. Li or DVA + buproprion
BD Depression: DVA, lurasidone. Combo seroquel + SSRI, Li or DVA
Ziprasidone Short- +DVA
Lamictal. Li or DVALi ++ Lurasidone.
+ venlafaxine. MAOI. Seroquel +
Take with fo acting IM
(Geodon) lamotrigine
Acute muscle Par
dystonia contractions diphenhydramine k motor deficits "Thorazine shuffle". D/C the AP
propranolol, benzo,
akathisia restlessness antcholinergic TD perioral mvmt d/c the AP in favor of SFA (Clozaril helpful)
 ADHD
Adderall (or generic) tablet

Adderall XR (or generic) capsule

Mydayis capsule
Amphetamines
Adzenys ER oral susp

Adzenys XR-ODT ODT

Evekeo tablet
Dyanavel XR oral susp
Dexedrine tablet
Dexedrine ER spansule
Dextroamphetamines
Procentra (and generic) oral sol
Zenzedi tablet
Methamphetamine Desoxyn tablet
Stimulants Lisdexamfetamine
(increase D2 Vyvanse cap or chew
and NE) Ritalin (or generic) tablet

Ritalin LA capsule
Ritalin SR tablet
Metadate CD capsule
Metadate ER tablet
Methylphenidates
Methylin ER (or generic) oral sol

Aptensio XR capsule
Quillichew ER chew

Jornay PM capsule

Focalin (or generic) tablet

Dexmethylphenidates

Focalin XR (or generic) capsule

atomoxetine
Nonstimulants (Strattera) NE ruptake inhibitor ADHD w/mania or psychosis
guanfacine (Tenex,
Alpha 2A Intuniv) sedating ADHD w/ BD:
agonists
(decrease BP)
clonidine (Catapres,
Kapvay) sedating ADHD w/ MDD:
Antidepressant Buproprion increases NE and D2
short acting, IR. 4-6 hrs

50% IR, 50% ER. 10-12 hrs.

Long-acting. 14-16 hrs
50% IR, 50% delayed. 10-12
hrs
50% IR, 50% delayed. 10-12
hrs.
IR. 4-6 hrs
ER. 13 hrs.
short-acing. 3-4 hrs
50% IR, 50% ER. 5-10 hrs.
3-6 hrs IR
IR. 4-6 hrs
IR 4-6 hrs
long acting, peaks at 3.5 hrs.
Lasts 10-13 hrs.
short-acting, IR. 3-4 hrs.
50% IR 8-12 hrs and 50%
DR, 2nd peak at 4 hrs.
sustained release, 8 hrs
30% IR, 70% DR. 8-10 hrs
ER. 8 hrs.
3-4 hrs
40% IR, 60% ER, 2nd peak 7
hrs. Lasts 12 hrs.
30% iR, 70% DR.12-13 hrs
delayed release up to 10
hrs.
short-acting, lasts 4-6 hrs

50% IR, 50% delayed. 8-12

hrs

Stop ADHD med. Add AP.

Treat BD 1st. Treat ADHD
once stable.

buproprion or AD and long-

acting stimulant or
venlafaxine.