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Psychopharmacology

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Thoughtful Prescribing, Not Reflexive Prescribing

There’s a version of psychiatric medication management that looks like this: a short appointment, a quick assessment, a prescription. Repeat every three months. My approach doesn’t look like that.

Medication, when it’s part of care at Beacon Psychiatry, comes after we’ve developed a full picture of who you are and what’s going on. It’s chosen carefully, explained clearly, and revisited regularly. And when it’s no longer serving you, that matters too.

- What Is Psychopharmacology -

What Is Psychopharmacology

Psychopharmacology is the study of medications that affect how we think, feel, and function emotionally. It’s not just about what a medication does in the brain. It’s also about how your whole body processes it.

Age, medical conditions, diet, alcohol use, exercise, and pregnancy can all change how a medication works for you specifically. What helps one person may not be the right fit for another, even with the same diagnosis. That’s why every prescribing conversation I have is specific to you, not to a category.

Psychiatric medications are usually grouped by what they’re most commonly used to treat. But many medications work across a range of conditions beyond their original purpose. A mood stabilizer might also support sleep. An antidepressant might ease anxiety. Context matters, and a good prescriber knows how to read it.

- Common Medication Categories -

Common Psychiatric Medication Categories

  • Antidepressants
  • Antipsychotics
  • Mood Stabilizers
  • Sedatives
  • Stimulants and ADHD Medications

Antidepressants

Most commonly used for depression and anxiety, antidepressants also treat OCD, PTSD, chronic pain, and other conditions. They work primarily by affecting serotonin, norepinephrine, or dopamine activity. They take time, often several weeks, and finding the right one sometimes takes some adjustment.

Examples:

  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Lexapro (escitalopram)

Antipsychotics

Used for schizophrenia, bipolar disorder, and severe depression, and sometimes added in lower doses to support other treatments. Their name can feel alarming if you don’t have psychosis, but they have a much broader range of clinical uses. I’ll always explain why I’m recommending one before anything is prescribed.

Examples:

  • Abilify (aripiprazole)
  • Seroquel (quetiapine)
  • Zyprexa (olanzapine)

Mood Stabilizers

Most often used in bipolar disorder to reduce the severity and frequency of mood episodes. Some also treat epilepsy, chronic pain, and impulsivity. This category includes medications with very different mechanisms, so figuring out which one fits requires careful clinical reasoning.

Examples:

  • Depakote (divalproex)
  • Lithium
  • Lamictal (lamotrigine)

Sedatives

Used for anxiety, insomnia, and acute situations. They work quickly, which can feel helpful in the short term, but they carry real risks of dependence and withdrawal when used long-term. I approach this category with particular care.

Examples:

  • Klonopin (clonazepam)
  • Ativan (lorazepam)
  • Ambien (zolpidem)

Stimulants and ADHD Medications

The primary treatment for ADHD, stimulants increase dopamine and norepinephrine activity in the brain. When prescribed thoughtfully and monitored carefully, they can make a meaningful difference in focus and daily functioning. Non-stimulant options also exist for patients where stimulants aren’t the right fit.

Examples:

  • Adderall (amphetamine salts)
  • Ritalin (methylphenidate)
  • Strattera (atomoxetine) – non-stimulant option
- Dr. Gupta's Background -

My Background in Psychopharmacology

I completed a psychopharmacology fellowship focused on psychiatric medication and including deep study of psychotomimetic substances, including ketamine, THC, amphetamines, and salvia. I went on to serve on the faculty at Yale School of Medicine and Mount Sinai, where I taught psychopharmacology to medical students and residents and worked as a research clinician on multiple investigational drug trials for schizophrenia.

I’ve authored more than 15 highly cited papers on marijuana, deprescribing, and psychosis, and I co-wrote the first book on psychiatric deprescribing published by Oxford University Press.

- Prescribing Philosophy -

Prescribing With Intention

I take a cautious, thoughtful approach to prescribing. That means a real first appointment before anything is started. It means explaining what a medication is expected to do, how to take it, and what to watch for. It means checking in regularly and adjusting when needed. And it means that if a medication has outlived its usefulness, we have that conversation rather than avoiding it.

If you’re considering starting medication for the first time, or if you’re already on medications and wondering if your current regimen still makes sense, I’d be glad to talk it through.

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- Link to Deprescribing -

What About Deprescribing?

Sometimes the most important clinical move isn’t adding a medication. It’s removing one. Deprescribing is the careful, systematic process of reducing or stopping medications when their risks outweigh their benefits. It’s collaborative, planned, and never rushed.