For educational reference only. Always verify dosing against the current BNF and local formulary. Does not replace clinical decision-making.
SSRIs — Selective Serotonin Reuptake Inhibitors
First-line antidepressants for depression and anxiety disorders. Inhibit the serotonin transporter (SERT), increasing synaptic serotonin. Generally well tolerated with a favourable side-effect profile compared to older antidepressants.
Inhibit both serotonin (SERT) and noradrenaline (NET) reuptake transporters. Useful for depression, anxiety disorders, and neuropathic pain. Blood pressure monitoring required due to noradrenergic effects.
Other Antidepressants (Mirtazapine, TCAs, MAOIs)
Includes noradrenergic and specific serotonergic antidepressants (NaSSA), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). These have distinct mechanisms, side-effect profiles, and monitoring requirements.
First-Generation (Typical) Antipsychotics
Block dopamine D2 receptors. Effective for positive symptoms of psychosis but carry significant risk of extrapyramidal side effects (EPS) and tardive dyskinesia. Generally not first-line for new presentations.
Second-Generation (Atypical) Antipsychotics
Block dopamine D2 and serotonin 5-HT2A receptors. Generally first-line for psychosis. Lower EPS risk than FGAs but significant metabolic side effects (weight gain, diabetes, dyslipidaemia). Clozapine is the gold standard for treatment-resistant schizophrenia.
Mood Stabilisers
Used in bipolar disorder and other conditions requiring mood stabilisation. Lithium has the strongest evidence for suicide prevention. Valproate is teratogenic and subject to the PREVENT programme. Lamotrigine is preferred for bipolar depression prevention.
Anxiolytics and Hypnotics
Includes benzodiazepines, Z-drugs, and buspirone. Benzodiazepines and Z-drugs carry significant dependence and tolerance risk. NICE recommends short-term use only (2–4 weeks maximum). Buspirone is non-addictive but has delayed onset.
ADHD Medications
Stimulant medications (methylphenidate, lisdexamfetamine, dexamfetamine) are first-line for ADHD. Non-stimulant alternatives (atomoxetine, guanfacine) are used when stimulants are contraindicated or not tolerated. All stimulants are controlled drugs.
Dementia Medications
Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) are first-line for mild-to-moderate Alzheimer's disease. Memantine (NMDA antagonist) is used for moderate-to-severe Alzheimer's. These medications are symptomatic — they do not alter disease progression.
Substance Misuse Medications
Medications for opioid dependence (methadone, buprenorphine, naltrexone), alcohol dependence (acamprosate, disulfiram, naltrexone), and nicotine dependence (varenicline, NRT). All require specialist prescribing and monitoring.
