A Practical Guide To Psychiatric Medications For Addiction Care (Update from 2025)

Psychiatric meds can feel like a maze when someone is trying to get sober and also sleep, focus, and stop panic spirals all in the same week. We made this updated, practical overview to simplify psychopharmacology for addiction treatment and recovery, using plain language and real clinical decision-making instead of jargon or hype.

We start by clearing up a viral rumor and then zoom out to how medications are actually created: research pathways, FDA indications, “me-too” drugs, and why off-label prescribing is so common in psychiatry. From there, we walk through the major medication classes and what they are truly used for, including antidepressants (SSRIs, SNRIs, mirtazapine, bupropion), anxiety and insomnia options that are less risky in recovery, and the basics of antipsychotics and mood stabilisers for severe symptoms like psychosis and bipolar disorder. We also touch on pharmacogenomics testing such as GeneSight and why individual response can still require careful trial and adjustment.

Because addiction medicine demands extra caution, we spend real time on benzodiazepine risks, why Z-drugs like Ambien can be problematic, and what we reach for instead when someone needs immediate anxiety relief while antidepressants take weeks to work. We wrap with a clinical case that shows how we prioritise conditions, pick meds that can treat more than one target, and avoid starting too many at once.

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To contact Dr. Grover: ammadeeasy@fastmail.com

Transcript

Origin Story And Updated Lecture

SPEAKER_00 0:08

Hi, I'm Dr. Casey Groove. I spent years practicing emergency medicine before shifting my focus to addiction medicine. This podcast grew out of caring for patients, hearing their stories, and wanting to do better. Here we talk about recovery, medicine, and compassion. This is Addiction Medicine Made Easy. Today we are going to be talking about psychiatric medications, as in water antidepressants, and what non-addictive meds can be used to treat ADHD, things like that. And you might be thinking, hey, Dr. Grover, we did an episode like this last year. And you would be right. We did do an episode like this last year. As you all know, I do education for the staff at the Residential Drug and Alcohol Treatment Program, where I am the medical director once a month. And last year they asked me to give an overview of psychiatric medications, and it was great. I recorded it and put it on the podcast. And this year I was asked, as there are some new staff, to give an updated version of my overview of psychiatric medications lecture. So here we are. Here's my updated version of an overview of psychiatric medications. It turned out great. I really hope that you will find it helpful. A quick reminder: if you haven't done so already, please consider submitting a rating or a review for this podcast on your Podcatcher app. It literally can just take a few seconds and it helps the podcast grow. Here we go. All right, so we uh are gonna do a review of psychiatric medications and psychopharmacology. It's always a great review. I added to this lecture that I gave last year, so it's newer and better and cooler. We'll see if you all agree. And

The Viral Bed Bug Myth

SPEAKER_00 2:06

the first thing is we just need to talk about smoking bed bugs. So at the end of our last time together, someone said, Hey, kids are smoking bed bugs. Can we talk about it? And apparently, what happened is there was a video and some stories about kids smoking bed bugs to get high. And it just took off on the internet and in social media. And fortunately, it is not true. So apparently, what it was, this was a story about teens smoking a different drug, and it was edited to to say that the teens were smoking bed bugs. There was this made-up molecule that was literally just fabricated that was supposed to be the active ingredient in bed bugs. It was all absolutely made up. If you smoke bed bugs, it will not do anything except be really gross. So now that the bed bug myth is put to rest, let's go on to psychopharmacology.

How Meds Are Made And Used

SPEAKER_00 3:02

Okay, so again, this is a lecture we did together last spring. It's always a great review to talk about how medications work, particularly psychiatric medications, as so many of our patients have mental health conditions in addition to their addiction. So, just a brief review of how we get medications. We as medical scientists, researchers, and doctors try to understand how the brain and body work. We understand different pathways, different receptors, different molecules. And we often find something that contributes to a normal process, and we try to understand how it works when this process goes wrong. Can we create a potential target to bring it back to normal? So for diabetes, we know that the blood sugar goes up too high. There's various hormones like insulin that are involved bringing it down. And so we research that pathway of how insulin works in the body and how blood sugar is controlled to come up with new medications. We initially start by trying new molecules and trying to understand it. We actually usually experiment on either in some sort of model or in animal studies. And then eventually we are able to identify a molecule that could be a new medication. And then the company contacts the FDA, the Food and Drug Administration to say, hey, we've got a new med. Let's try it out. There's a series of experiments that are done, initially a very small study to see if it's toxic. As it shows promise, we do bigger studies to identify major safety issues. And then if we find it's promising that it does what it's supposed to do and it doesn't hurt people, it goes on to a larger study. And if it shows that it works and doesn't hurt people, it becomes a medication that we can prescribe. Now, when people are bringing a new drug to market, they have to give what it's going to be used for. So let's say, again, coming back to diabetes, researchers find a new pathway that controls the blood sugar. And the indication for which the medication is approved for doctors to use is diabetes. Now, in America, we have for-profit healthcare. So once this pathway and medication is developed, other rival pharmaceutical companies realize that, hey, this pathway could work for us too. Let's tinker with the design, let's make a similar drug. These are often called Me Too drugs. So, for example, there's omeprozole for acid reflux. There's also pantoprazole. There's a cousin. So there's lots of different versions of the initial medication. And as another example, the first selective serotonin reuptake inhibitor Prozac, also known as fluoxetine, when it came out, it was shown to be really helpful. Multiple pharmaceutical companies made similar drugs. Now, as I mentioned, when we're studying a drug and bringing it to market, we find that it's supposed to be used for a particular indication. But as we use it, patients start to tell us that it might do other things. And as we use it across thousands and even millions of people, it gives us more data and more experience than the initial smaller studies that we use to bring the drug to market. And this is what is called off-label. So I'll give you an example of Topamax, also known as topiramate. So the approved indications are seizures and preventing migraines. So when I look on my drug reference, this is what I can use this medication, topiramate or topamax for, treating seizures or preventing migraines. But what we found is when we prescribed it to many people, they'd say, hey, doc, does this medication make you eat less? I'm not as hungry. Or, hey, doc, does this medication make you not want to drink? I actually had one of my staff in the office who was on Topirimate, also known as Topamax for migraine prevention. And she literally asked me one day, hey doc, does this medication make you not want to drink alcohol? And what we find is that there are these unexpected positive side effects or other unexpected benefits where the medication can be used for other things. So off-label use of this medication would include binge eating, weight loss, alcohol use disorder, and stimulant use disorder. And so once a medication's on the market for a long period of time, we find that can actually be used for other things. Here's another example: the sleeping medication trazidone. You probably all know from your work treating patients with addiction, particularly in residential, that we use it all the time for insomnia. It turns out that it's only FDA approved for depression. And what's funny is it works so much better for insomnia than depression that we actually, as doctors, almost exclusively use it for insomnia. So we again understand a medication gets brought to market, it gets studied, and as we have more experience with it, we find that it can be used for more things. Now,

A Practical Framework For Medication Classes

SPEAKER_00 8:07

you guys might remember this from last year. I'm a simple guy. I like to make analogies that are easy to understand so I can keep them straight in my brain and for my patients. And if there's one thing we love as Americans, it's our cars. And here's how I make it make sense for my patients. There are different types of cars. There's trucks, there's SUVs, there's sports cars, and people understand those basic broad categories. And so people will ask me, Dr. Grover, I'm on medication A. I want to go to medication B. How different are they? And I'll say, it's like a GMC Sierra and a Chevy Silverado. They're essentially the same truck. And people are like, oh, I get it. I don't know why we need to have the same truck for two different manufacturers, but we do. So medication A and medication B are so much similar that it's really hard to notice the difference between the two. As I like to say, it's like GMC and Chevrolet. Now, sometimes we find that medications are in the same class, but they have some subtle differences between them. I love trucks. So a Ford F-150 is a full-size truck and a GMC Sierra is a full-size truck, but they're different. They're made by different manufacturers, they have different consoles, they might have different settings. And I'll tell my patient they're similar, but there are some notable differences. It's like a Ford F-150 and a GMC Sierra. And they'll be like, ah, that makes sense, Dr. Grover. Overall, you use it for the same thing, but there might be a reason you want one more than the other. And then some people will ask me, hey, Dr. Grover, I'm on medication A. Can I switch to medication B? And I'm like, those are not even in the same category. They're not interchangeable. They can't be used for the same thing. It's like a big full-size truck and a sports car. You're not going to take the sports car to tow a trailer, and you're not going to take the truck to the racetrack. They just have different reasons to use them. So, with that framework, and this is one of my favorite graphics of a hamster trying to eat an entire carrot stick, we are going to try to take on all of the different psychiatric medications in 40 minutes. So we have definitely bitten off more than we can chew. So we're going to try to keep things at a very high level just so we understand roughly the classes of the different meds, which are good choices for certain conditions, and then what do I often do in my practice? So

Antidepressants For Anxiety PTSD And More

SPEAKER_00 10:34

the first class of medications we're going to talk about are antidepressants. And the first thing to know about antidepressants is they do more than treat depression. One of my colleagues, Dr. JP Meckle, I have to give him credit here, he describes antidepressants as giving people more emotional resilience. What does that mean? People can take on more stress in their day and not feel overwhelmed. I always tell this to my patients let's imagine your kid is throwing a tantrum, your dog pees on the floor and you're late for work, you might be totally overwhelmed and ready to break down and cry. With an antidepressant in your system, you're more able to take those stressors in stride, think through the problem, and not completely feel overwhelmed. They do help with depression, they help with anxiety, they help with PTSD, and there are some nuances between the different classes, which we'll talk about. Anyone who attended my lecture last year will remember these graphics. Patients often find it frustrating that a lot of what we do in starting medications is really trial and error. And this is a screenshot from a test that a company called GeneSight does. I have no relationship with the company, except I like their test and I order it. But there's actually some research in what's called pharmacogenomics, which is the interaction between a person's genetics and how they metabolize medication. And so this company, they you take a cheek swab and it takes some of the DNA out of your cheek cells and they analyze it and they tell you whether you metabolize a medication too quickly, so it's not a good fit, or you metabolize a medication too slowly and it's not a good fit. But the reason why I included this screenshot is it gives you a list of all of the different medications that are considered antidepressants, and it gives them the generic name and the brand name. So let's go through some ones people will know. Certrale is the generic name, Zoloft is the brand. Duloxetine is the generic, Cymbolta's the brand. Buproprian's the generic, well butrin's the brand. Okay? And quite honestly, for a lot of these, I can't remember them, and I have to look them up in my drug reference. So if you need to look them up, totally normal. We're just trying, again, keep it high level. So there's six basic groups of antidepressants, the selective serotonin reuptake inhibitors, brand names people will recognize Zoloft, Prozac, Lexapro. That's one chemical system in the brain that gets affected by the drug, which is serotonin. The newer ones involve serotonin and norepinephrine. Those are called SNRIs, or serotonin and norepinephrine reuptake inhibitors. Some brand names you might recognize are Symbolta and Affexer. Older antidepressants tend to have poor safety profiles, and some of the classes include tricyclic antidepressants like amitriptyline and then monoamine oxidase inhibitors. And we tend to not use these much just because they do have more side effects. So I don't tend to use them a ton in my practice. Merttazepine is one that you might recognize, also known as Remaron, and then buproprian, also known as well butrin. So let's go through what they can be used for. So let's look at selective serotonin reuptake inhibitors. You can see here there's a wide variety of what they can be used for. And again, think about the add emotional resilience, major depression, anxiety, social anxiety, panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, a perimenstrual dysphoric disorder. That's the new name for when women get emotional around their period. Bulimia, binge eating disorder. These are really useful medications. And somebody might come to me and say, Dr. Grover, I have anxiety and PTSD. I feel horrible. I don't know which one it is. For me as a doctor, it's great. I don't actually have to know if I start them on one of these medications, an SSRI, it's gonna help both. Now, let's move on to the next category, which are the SNRIs, the serotonin and norepinephrine reuptake inhibitors. Take a look at all they can be used for: major depression, anxiety, social anxiety, panic disorder, PTSD, fibromyalgia, peripheral neuropathy, ADHD, menopausal hot flashes. Now, if you look on this list though, really only Venlofaxine or effects are has shown the most promise with PTSD. For things like pain, fibromyalgia, and peripheral neuropathy, we use deloxetine, also known as cymbalta. And that brings up what I like to call flavors. So you can see on the screen I put up some pictures of different ice cream flavors. It's all ice cream, but there are different flavors, meaning that each one of these antidepressants has a little bit of a different way it works. So if a person needs to be on one of these meds, an SNRI, let's say they have depression and pain, duloxetine or cymbalta might be the best fit because it manages both. Going back to our selective serotonin reuptake inhibitors, same thing. Paxyl or peroxetine is a little bit more sedating. Prozac, also known as fluoxetine, is a little bit more activating. Some are associated with weight gain, some are associated with weight loss. And again, there's this nuance of kind of these unique little flavors of each of the antidepressants. So that's a lot of what I do as a doctor, is try to tease out all the patients' different problems and find the med that's going to work best for them. I mentioned some of the older meds, tricyclic antidepressants, often can be helpful for chronic pain. I really don't use monoamine oxidase inhibitors in my practice. If someone needs that, I'll usually refer them to psychiatry because they have more medication interactions and sometimes even food interactions. And that leaves us with the last two. Mertazepine, also known as Remeron, is very sedating. So a lot of times we use it for sleep. As a side effect, it increases appetite. So sometimes people will say, I'm really struggling, I'm losing weight because I have no appetite. That could be a good fit. And it also has some promise around stimulant use disorder in reducing stimulant cravings. And one of the ways it really helps people with stimulant use disorder is stimulants are very disruptive to sleep. And mertazepine, also known as rhemoron, can really help restore some of the sleep architecture that gets disrupted by stimulants. The last one, buproprian, also known as well butrin. In addition to depression, it can also be used for ADHD, stimulant use disorder. That's usually my go-to for someone coming off of methamphetamine. And it can be also used to help people quit smoking. Okay. So let's go on to our next major class of drugs. You can imagine

Treating Anxiety And Insomnia Without Benzos

SPEAKER_00 17:47

we've switched now from trucks. If we're going to say trucks or antidepressants, now we're moving on to sedans. It's a totally different class of drugs. And we're going to look at the anziolytics and hypnotics. These are medications that are usually downers. You think of them as having that anxiolytic anxiety-reducing effect. The first group within this category are the benzodiazepines. We also have the Z drugs like zolpidem, also known as ambien for sleep. There's boosperone, which is in its own category. We have medications that were traditionally used to treat high blood pressure, but have additional benefits in treating anxiety and finally antihistamines like hydroxizine. So let's take a look here. Here's again a list of all these medications. You guys recognize alpraazolam, xanex, that's benzodiazepine, zolpidem, that's one of those Z drugs. Valium diazepane, that's another benzodiazepine, propranolol. These are again all these medications in the anxiolytic and hypnotic category. As we'll talk about, I really struggle with benzodiazepines. They really cause, in my humble opinion, more problems than they're worth. And they do have some long-term neurological and psychiatric side effects that we're just learning about. And I'll cover that later. And I'll give you my recommendations on which are the safest medications to treat anxiety shortly. Okay.

Antipsychotics Mood Stabilizers And ADHD

SPEAKER_00 19:15

Next step, again, we're switching classes entirely, are the antipsychotics. So these are medications that were brought to market to treat thought disorders like schizophrenia or psychosis. A lot of them do have benefit in acting like mood stabilizers to treat bipolar disorder. And largely what these are used for is when people are in that psychotic state. I don't want to use the word psychotic because, again, these are antipsychotics. It's really when people have lost the ability to appreciate reality. They're in alcohol withdrawal and they're hallucinating. They haven't taken their medication and they're having a lot of paranoid delusions in their schizophrenia. They stop taking their mood stabilizer and they're in a manic state. They tend to be very sedating. And we'll look at some names here. There's three generations. The oldest generation are medications like chloropromazine, also known as thorazine, haloperidol, also known as Haldol. These are very old medications. They can be very effective, but they're very sedating. The second generation are medications like allanzepine, also known as Zyprexa, or Ziprazidone, also known as geodon. These had a better side effect profile. These cause fewer problems with feeling stiff and kind of getting muscles feeling really stuck from the older generations. The major issue with the second generation is that they tended to cause a lot of weight gain. Cation or cerequel is also in the second generation. Some of the second generation meds could also be used as mood stabilizers. You'll see people on cation, also known as cerequel for bipolar disorder. And then the third generation, again, they've improved that side effect profile even more. These are things like aerizole, also known as Abilify. And we've just seen that people tolerate them better. Next category, again, we're totally switching models. Now we're going to say convertible sports cars, totally different class of meds. These are mood stabilizers. And these medications are predominantly used for bipolar disorder. And let's just do a quick review on what bipolar disorder is. So a mood disorder is something where the mood changes. When the mood is down, that manifests as depression. When the mood is up, that manifests as mania. So both bipolar disorder and depression are mood disorders. But depression is unipolar, meaning the mood only goes down into depression. Bipolar is when the mood goes up. Up into mania and down into depression. And largely these mood stabilizers help to make antidepressants work better for depression. They treat mania, meaning if someone has a manic state, they'll bring them back from that. And they are used to prevent mania when someone has bipolar disorder. And unfortunately, if someone has bipolar disorder and they're put on an antidepressant, sometimes that antidepressant lifts their mood not just to normal from depression, it can push them above and into mania. So usually if someone with bipolar disorder is on an antidepressant, it's done with a mood stabilizer to prevent pushing them into mania. So here are some that you might recognize valproic acid, also known as depicote, lamotrogen, also known as lamicdol, tapyrinate, also known as topamax, and lithium. And just going back to antipsychotics, some of the antipsychotics are also used as mood stabilizers. Some of the common ones, aripiprazole, also known as abiliphy, cotiapine, also known as cerequel, alanzepine, also known as iprexa. The second and third generation antipsychotics have a dual use as a mood stabilizer. For me as an addiction doctor, I treat a lot of depression, I treat a lot of anxiety, I treat a lot of PTSD, I treat a lot of insomnia. Bipolar disorders, much more complicated, and I usually ask for the help of a psychiatrist. And then we just talked about antipsychotics. If someone does have schizophrenia, I cannot manage that. That absolutely needs the help of a psychiatrist. I'm not trained to do that. Okay, the last class of medications that we're gonna look at are the ADHD medications. Again, we've changed the type of car altogether. Now we're looking at limousines. Totally different, right? And there's two main classes of ADHD meds. There are the stimulants, which are basically pharmaceutical speed, and then the non-stimulants. And given my practice as an addiction medicine doctor, putting someone with a history of addiction on stimulants makes me really nervous. The last thing I would want is to make their addiction worse. So our practice focuses on the use of non-stimulants. Here are some medication names that you might recognize on the non-stimulants, adamoxetine, also known as Stratera, Guanfysine, there's also phylloxine, also called Kelbry, and then clonidine as well. And what we'll talk about is some of these medications have more than one use. And what I try to do is to find medications that do the most for a particular patient's mental health and addiction at the same time. Just to be thorough, I will show you here also the name of the stimulant, ADHD meds. There's dexmethylfenidate, there's methylphenidate. You might recognize the name Ritalin, that's methylphenidate. Adderall, the generic name of Adderall, is amphetamine. If you wonder why it's addictive, yes, it's amphetamine. And then they've altered the amphetamine molecule to create dexroamphetamine and LIS dexamphetamine. Okay, so what do I use the most of? A lot of my patients have some sort of mood disorder, whether it's they're depressed because of alcohol, or they drink alcohol because they're depressed, whether they have PTSD. A lot of my patients have some sort of depressive aspect of their addiction. So I am very liberal with getting people on an antidepressant. And again, the way I think of it, it gives you more emotional resilience. I usually start with an SSRI. As you may recall, they do treat a few more conditions than the SNRIs. As someone's been on a few SSRIs, I will then try an SNRI. And then for folks who have a history of stimulant use or smoking, buproprian, also known as well, but always a good choice. For anxiety, as we've talked about, the antidepressants increase emotional resilience and absolutely help with anxiety. The only problem is they take several weeks to work. So when someone is anxious, a lot of times we want to put them on a medication that can help them in real time when they're just feeling overwhelmed, while the several weeks need to go by for the antidepressant to kick in. So there's hydroxizine, which is a sedating antihistamine. Clonidine or propranolol are two medications that are used for blood pressure that make anxiety much less intense. There's boosperone. The old brand name was boospar, and now it's just generic boosperone. And that one's a little nuanced. Some people tell me, doc, when I take it, I feel better right away. But usually how it's prescribed is it's taken daily and anxiety gets better over time, like antidepressants. And then the last one we use pretty regularly is gabapentin. Benzodiazepines, I do not use for anxiety on any sort of prolonged basis. Unfortunately, they change brain chemistry to actually increase anxiety over time. Now, that being said, let's say somebody is really anxious about going to the dentist and they want one valium to go get a dental cleaning, no big deal. But unfortunately, many patients, as we all know, were prescribed benzadazepines years ago and really struggle with anxiety if they try to get off of them. In terms of medications for sleep, these are the four that I most use. We talked about trazodone is a sedating antidepressant. Mertazepine, also known as remaron, is a sedating antidepressant. Hydroxazine is a sedating antihistamine like benadryl or diphenhydramine. Some people respond well to that. And we haven't talked about this med yet, but there's also a medication called Romelteon. The brand name is Rosarem. And it's basically like melatonin 2.0. It actually changes how the melatonin system works in the brain and makes it work better. It's another good non-addictive sleep medication. As I have mentioned, things I avoid, benzodiazepines, long-term increased anxiety, very frustrating class of medications. People get put on benzos because they're anxious. Two years go by, they want to get off of them, and their anxiety is actually worse as they try to taper off of it. I can talk about this at length in a future lecture, but we are learning about the condition called benzodiazepine-induced neurological dysfunction or bind, which is the name for this condition where benzodiazepines worsen anxiety over time. The other thing I tend to avoid are the Z drugs, again, like Zolpidem or Ambien. There's Esopiclone or Lunesta. And these are a cousin of benzodiazepines and work fairly similarly, so I try to avoid them as well. Now, you might be asking, okay, Dr. Grover, you just showed us like 150 different medication names. How do you choose which one?

How We Choose Meds Step By Step

SPEAKER_00 29:09

The first is I make a list of all the conditions that they have. Right? They might have anxiety, depression, PTSD, and alcohol addiction. Okay, let's make a list. We want to treat each of them. I usually ask, what meds were you on before? And people will say something like, Oh my gosh, when I was on Zoloft, it was so helpful. Great. That's perfect information. Let's put you back on Zoloft. Again, the generic name there is Certaline. And if they really don't have any history with medications, I'll ask them and work with them to use my clinical judgment, which is the most urgent issue. Is it their alcohol cravings? Is it their insomnia? Or is it their anxiety? And it might be that if we get their anxiety better, their alcohol cravings go down. So that's what we're going to focus on first. Once I start patients on a medication, I reassess them. I try to avoid starting more than two medications at the same time. Because if I start four medications and people don't feel good, it's hard to know which medication is the culprit. So the first thing I do when I see them in follow-up and reassess them, are they having side effects? Are these side effects manageable? If they're not, we may need to go a different direction. One of my patients recently had a pretty significant side effect to an SSRI. We're going to avoid that entire class of meds entirely and shift to SNRIs. Now let's say they tell me they aren't having side effects. Hey doc, it's actually helping a little. Great. Let's increase the dose and see you back in a few weeks. How are you doing? Once we feel like the medication started to help, then we're ready to start moving on to address the less urgent conditions they have and start additional medication. Now, people always ask me, Dr. Grover, do I have to be on these meds forever? Depends on the condition. Some conditions are chronic and permanent, and people need to be on medications for life. And the biggest example there is schizophrenia. Now, some people need to be on medications for a short period of time. Let's say someone has an alcohol use disorder and depression, they're really depressed coming off of alcohol. We get them into meetings, we get them into therapy. And as we get them on an antidepressant and the therapy and the meeting start to work, they're going to get better, and we may not need to have them on an antidepressant forever. Now, one emerging trend in medications is patients, myself included, often have a tough time remembering their medications. Or they may not want to be on medication, like in the case of schizophrenia. And so we now have once-a-month injections of different psychiatric medications so that people can't forget doses and get worse. Or with schizophrenia, there's a lot of paranoia. That's a part of the disease. Unfortunately, patients with schizophrenia can get paranoid about their medications for schizophrenia and not take them. So a once-a-month shot keeps the patient in treatment and keeps the medication working. Think of it like sublicade for our soboxone patients, but it's for psychiatric medication. Okay,

Clinical Case And Key Takeaways

SPEAKER_00 32:29

we're gonna do a quick clinical case here and then we're gonna wrap up. So I wrote this up this morning. A 35-year-old female has a history of stimulant use disorder, ADHD, and PTSD from a bad relationship with domestic violence. She's never been on psych meds. This is her first time in treatment. Which medications could be the most useful for her? Here's her problem list stimulant use disorder, ADHD, and PTSD. And remember, we want to avoid starting too many medications at the same time. I could start one medication for each condition, but it's hard to remember three meds. And then if there's side effects, which is the coper? So let's make a list of which medications could be helpful for her. These are medications that could be used to treat two of her conditions. Well, butrin, also known as buproprian, can treat stimulant cravings, can be helpful for ADHD. Affexor, also known as venlofaxine, can absolutely be helpful for PTSD. And there's some evidence that it could be helpful for ADHD. It's not as robust as, say, adamoxetine, that's against Tratera, but it can help with ADHD. And then clonidine, because it's used for anxiety, can also help with PTSD. And because it reduces impulsivity, can also be helpful for ADHD. So here I have three different medications. By starting one of them, I can treat two of her conditions. And I like that, right? We want to get the patient as much bang for their buck with medications. So I sit down and talk with the patient. She feels, Dr. Grover, I'm really craving stimulants. I don't want to relapse. And Dr. Grover, I cannot focus. The AA meetings are useless for me. The MA meetings are useless for me because I can't pay attention. I'm so distractable. And she's having trouble engaging with her therapist because of distractability from her ADHD. So we prioritize that stimulant cravings and ADHD are her biggest issues. So coming back to this slide, the well butrin, also known as bupropriane, can help with stimulant cravings and ADHD. She also has PTSD. So the clonidine can help that a little bit, but will also help with ADHD. So by treating her with that combination of bupropriane and clonidine, we have one medication for stimulant cravings, two medications for ADHD, and one medication for PTSD. So the plan is to start clonidine and bupropriane, also known as well butrin, and to reassess. And if she's doing great in a few weeks, I can always add in another medication in the future. Okay, so that was our whirlwind tour of psychiatric medications. And let's see what questions people have. Thank you so much for listening to Addiction Medicine Made Easy. If you found this helpful, please leave a review. It really helps others find the show. And a huge thank you to Central Coast Overdose Prevention for supporting this podcast. And always remember treating addiction saves lives.