Psychiatric medications, prescribed online.
Medication is not the right answer for everyone, but when it is, it should not take 6 weeks and 3 phone trees to get it. Siggy prescribers treat the most common mental health conditions with evidence-based, non-controlled medications, prescribed through a licensed clinician.
This page covers what we prescribe, how each class works, and what we deliberately leave out.
Antidepressants: SSRIs and SNRIs.
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed first-line medications for depression and anxiety disorders. They work by increasing the availability of serotonin between neurons, which, over several weeks, helps regulate mood, worry, and the stress response.
Common SSRIs we prescribe include sertraline, escitalopram, fluoxetine, paroxetine, and citalopram. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and duloxetine act on both serotonin and norepinephrine, and are often used when an SSRI alone is not enough, or when chronic pain co-occurs with depression.
What to expect: SSRIs and SNRIs typically take 4 to 8 weeks to reach full effect. Early side effects, such as nausea or sleep changes, usually fade within the first 2 weeks. Your prescriber will schedule follow-ups during this window rather than leaving you to guess.
Conditions treated: depression, generalized anxiety, panic disorder, social anxiety, OCD, PTSD.
Atypical antidepressants.
Not every brain responds to serotonin-focused medication. Bupropion works on dopamine and norepinephrine, tends to be energizing rather than sedating, and does not carry the sexual side effects common to SSRIs. Mirtazapine can help when depression comes with insomnia or appetite loss.
Beta blockers.
Propranolol is a blood pressure medication used off-label to blunt the physical symptoms of acute anxiety: racing heart, shaking hands, trembling voice. It does not treat the psychological side of anxiety, which is why it is most useful for predictable, situational anxiety such as public speaking or performance settings. Off-label use is common and well studied, and your prescriber will tell you explicitly when a medication is being used off-label.
Non-stimulant ADHD medications.
Siggy treats ADHD with FDA-reviewed non-stimulant medications. Atomoxetine and viloxazine are approved non-stimulant options that improve attention and impulse control by acting on norepinephrine. Alpha-2 agonists such as guanfacine ER and clonidine ER are also used, particularly when hyperactivity, emotional reactivity, or sleep problems are prominent (adult use of alpha-2 agonists is off-label and will be discussed with you directly).
Non-stimulants take longer to work than stimulants, typically 2 to 6 weeks, but they carry no abuse potential, no scheduling restrictions, and steadier all-day coverage. For many adults, especially those with co-occurring anxiety, they are the better clinical fit, not the consolation prize.
Mood stabilizers.
For bipolar disorder, mood stabilizers remain the foundation of treatment. Lithium is the most studied medication in psychiatry for preventing mood episodes and reducing suicide risk, and lamotrigine is a first-line option for preventing depressive episodes in bipolar disorder. Both require lab monitoring, which Siggy coordinates through standard local lab draws.
Atypical antipsychotics.
Despite the name, these medications are used well beyond psychosis. Quetiapine, lurasidone, cariprazine, and aripiprazole are FDA-approved for bipolar depression or as add-on treatment for major depression that has not fully responded to an antidepressant. Your prescriber will discuss metabolic monitoring before starting any medication in this class.
Non-controlled sleep and anxiety medications.
For insomnia, we prescribe non-controlled options including ramelteon (a melatonin-receptor agonist), low-dose doxepin, and off-label trazodone or hydroxyzine. For anxiety, buspirone offers daily anxiety relief without sedation or dependence risk, and hydroxyzine can be used situationally.
Medication is rarely the whole answer for insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended for chronic insomnia, and your prescriber will be straightforward about that.
What we do not prescribe, and why.
Being straight with you
No benzodiazepines, no stimulants, no z-drugs.
Siggy does not prescribe controlled substances. That means no benzodiazepines (Xanax, Ativan, Klonopin), no stimulants (Adderall, Vyvanse, Ritalin), and no z-drugs (Ambien, Lunesta).
This is a clinical decision, not just a regulatory one. Benzodiazepines carry dependence risk and are recommended against for PTSD in VA/DoD clinical practice guidelines. Sedative-hypnotics lose effectiveness quickly and complicate the sleep problems they are meant to solve. For every condition we treat, there is a non-controlled, evidence-based path, and it is usually the one major guidelines recommend first anyway.
If your care genuinely requires a controlled substance, we will tell you and help you find in-person care rather than prescribing around the problem.
How prescribing works at Siggy.
Every prescription decision at Siggy is made by a licensed clinician. You complete a structured intake and meet with a prescriber. If medication is appropriate, follow-ups are built in during the adjustment window, and dose changes do not require starting over.
FAQs.
- How long until my medication works?
- Most antidepressants take 4 to 8 weeks for full effect, though sleep and energy often improve first. Non-stimulant ADHD medications take 2 to 6 weeks. Your prescriber sets follow-ups inside that window so adjustments happen early.
- Why don't you prescribe Adderall or Xanax?
- Siggy does not prescribe controlled substances. For ADHD, anxiety, and insomnia, effective non-controlled options exist and are frequently what clinical guidelines recommend first. If your situation requires a controlled medication, we will say so and point you to appropriate in-person care.
- What does "off-label" mean?
- It means a medication is FDA-approved for one condition and prescribed for another based on clinical evidence. It is a routine, legal practice. Your prescriber will always tell you when a medication is off-label and why it is being recommended.
- Can I switch medications if the first one doesn't work?
- Yes. Roughly half of people do not fully respond to the first antidepressant they try. Switching or adjusting is a normal part of treatment, not a failure.