Sebastián Malleza, M.D.

This guide covers the two first-in-class approvals of mid-2026, centanafadine for ADHD and oveporexton for narcolepsy type 1, alongside new guidance on OCD dosing thresholds, the serum lithium levels that drive renal risk, and the AASM's ranking of CBT-I against combination treatment for chronic insomnia.

This guide gives prescribers an evidence-based approach to antidepressant-associated hyponatremia: how the syndrome of inappropriate antidiuresis (SIAD) develops, which patients to monitor and when, how to recognize symptoms that may mimic depression, and how to manage and apply switching strategies afterward.

This guide examines gepirone, the first FDA-approved selective 5-HT1A receptor agonist for major depressive disorder; its favorable sexual side-effect profile and weight neutrality, dose-dependent QTc prolongation requiring ECG monitoring, mandatory food administration, and contraindication with strong CYP3A4 inhibitors. It also traces gepirone's unusually contested path to approval — four FDA rejections and a 2015 advisory-committee vote against its efficacy before the FDA approved it in 2023 on a modest evidence base.

This guide distills practical pearls from the 2026 ASCP Annual Meeting: deprescribing complex regimens by reconstructing each drug's purpose ("pharmacoarcheology"); interpreting what "FDA approval" does and does not mean; tailoring antipsychotic choice and dose to ancestry and metabolism (benign ethnic neutropenia and clozapine access, first-trimester safety); and montelukast's age-stratified neuropsychiatric effects.

This guide provides a comprehensive overview of dextromethorphan/bupropion — the first oral NMDA receptor antagonist approved for major depressive disorder and, as of April 2026, the first non-antipsychotic medication FDA-approved for agitation associated with dementia due to Alzheimer's disease. It covers the unique mechanism and rapid antidepressant onset in MDD, the indication-specific titration schedules (including the slower titration with the new 30 mg/105 mg tablet for Alzheimer's agitation), the supporting evidence, drug interactions driven by CYP2D6 inhibition, the newly added hyponatremia warning, and special considerations for elderly patients, CYP2D6 poor metabolizers, and other populations.

This guide addresses tricyclic antidepressant safety across the prescribing lifecycle: CYP2D6 inhibitor interactions (fluoxetine, paroxetine, bupropion), CPIC-guided dosing in poor and ultrarapid metabolizers, a structured monitoring framework, agent selection across pregnancy, breastfeeding, and older adults, and overdose recognition.

This guide examines tricyclic antidepressants as second- or third-line agents, covering the tertiary vs. secondary amine distinction and its implications for tolerability, a clinical decision framework for agent selection, AGNP-guided therapeutic drug monitoring with reference ranges for all six commonly used agents, dosing and titration strategies, and switching protocols.

This guide provides a comprehensive overview of buspirone, a 5-HT1A partial agonist approved for generalized anxiety disorder, covering its non-GABAergic mechanism, pharmacokinetics, significant CYP3A4 drug interactions, dosing strategies, side effects, various special population considerations, and clinical positioning as a non-sedating anxiolytic without significant dependence risk.

This guide provides a comprehensive review of trazodone, a serotonin antagonist and reuptake inhibitor (SARI) FDA-approved for depression but predominantly prescribed off-label for insomnia, covering its dose-dependent pharmacology, clinical uses, drug interactions, side effects including priapism and QT prolongation, and special population considerations.

This guide provides a comprehensive overview of 2025's key regulatory and guideline updates in psychiatry, covering new FDA approvals, label changes, and practice guidelines across depression, schizophrenia, addiction, neurocognitive disorders, and neurodevelopmental conditions, emphasizing practical implementation considerations for clinicians.

This guide provides a comprehensive review of serotonin syndrome, covering its pathophysiology, clinical presentation using Hunter Criteria, risk stratification of drug combinations, and severity-based management strategies including supportive care and cyproheptadine use.