Table 4.
Grading of treatment options according to safety issues following system shown in Table 1
| Agent/modality | Grade | Comments |
|---|---|---|
| Agomelatine | 2 | Elevation of liver enzymes |
| Allopurinol | 2 | Swelling of mouth and lips, severe skin rashes, infections, eye irritation, hepatitis, appetite and weight loss, and painful or bloody urination |
| Amitriptyline | 2 | Many adverse effects, some risk for cardiovascular events |
| Aripiprazole | 1 | |
| Armodafinil/modafinil | 2 | Stimulant, risk for abuse |
| Asenapine | 1 | |
| Bupropion | 1 | |
| Carbamazepine | 2 | Hepatic enzymes induction, many adverse effects |
| Cariprazine | 1 | |
| Celecoxib | 1 | |
| Choline | Food supplement | |
| Chromium | Food supplement | |
| Clozapine | 3 | Potentially lethal agranulocytosis, metabolic syndrome |
| DBS | 1 | |
| Diltiazem | 1 | |
| Donepezil | 1 | |
| ECT | 2 | Not preferred by patients, mild cognitive problems |
| Folic acid | Food supplement | |
| Gabapentin | 1 | |
| Galantamine | ||
| Haloperidol | 2 | Extra-pyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, switch risk |
| Imipramine | 2 | Cardiac side effects, many adverse effects, switch risk |
| Inositol | ||
| Ketamine | 3 | Transient dissociation and elevation of blood pressure |
| Lamotrigine | 2 | Good overall tolerability but potentially lethal skin reaction that can be avoided by slow titration |
| Levetiracetam | 3 | Induction of suicidality |
| Light therapy | ||
| Lisdexamfetamine | 3 | High risk for abuse and dependence |
| Lithium | 2 | Many adverse effects, weight gain, toxicity |
| Lovastatin | ||
| L-sulpiride | 1 | |
| l-thyroxine | 2 | Mild cardiovascular, skin and bone adverse effects |
| Lurasidone | 1 | |
| Magnesium | Food supplement | |
| Memantine | 1 | |
| Modafinil | 2 | Stimulant, risk for abuse |
| n-3 fatty acids | Food supplement | |
| N-acetyl cysteine | 1 | |
| Nimodipine | 1 | |
| Olanzapine | 2 | Metabolic syndrome |
| Omega 3 fatty acids | 1 | |
| Oxcarbazepine | 1 | |
| Paliperidone | 1 | |
| Paroxetine | 1 | Weight gain |
| Phenytoin | 2 | Many adverse effects |
| Pioglitazone | 2 | Not recommended in patients with diabetes mellitus type I and in liver disease Absolute contraindication in heart failure patients |
| Pramipexole | 2 | Adverse effects include the induction of compulsive behaviors and psychotic symptoms |
| Pregabaline | 2 | Risk of abuse, weight gain |
| Pregnenolone | 2 | Not well studied |
| Primidone | ||
| Quetiapine | 1 | Weight gain |
| Ramelteon | 1 | |
| Risperidone/RLAI | 1 | Increased prolactin, weight gain |
| S-adenosyl-L-methione | 2 | Some adverse effects; long-term effects unknown |
| Sleep deprivation | 1 | |
| TMS | 1 | |
| Topiramate | 3 | Induction of depression and suicidality |
| Tranylcypromine | 2 | Many adverse effects |
| Tryptophan | Food supplement | |
| Valnoctamide | 1 | |
| Valproate | 1 | Cautious use in women of childbearing age |
| Venlafaxine | 2 | Switch risk |
| Verapamil | 1 | |
| Ziprasidone | 2 | QTc prolongation, patient ECG recommended when used in combination |
Abbreviations: DBS, deep brain stimulation; ECG, electrocardiogram; ECT, electroconvulsive therapy; EPS, extrapyramidal signs; RLAI, risperidon long acting injection; TMS, transcranial magnetic stimulation.