Psychotherapeutics - Therapeutic Classification

Antidepressants
Generic Name(s)	Strength	Dosage Form	ICD Code
Amitriptyline and Perphenazine	2/10mg	Tablets	Y49.0
Dothiepin
Milnacipran Hcl	12.5mg, 25mg, 50mg, and 100mg	Tablet
Protriptyline Hydrochloride	5mg, 10mg	Tablet	Y49.0
Reboxetine	2mg, 4mg	Tablets	Y49.2
Tianeptine	12.5mg	Tablets

Antidepressants, Atypical
Generic Name(s)	Strength	Dosage Form	ICD Code
Bupropion	75mg, 100mg	Tablet	Y49.2
Bupropion, Sustained Release	100mg, 150mg, 200mg	Tablet	Y49.2
Bupropion, Sustained Release	150mg, 300mg	Tablet	Y49.2
Mirtazapine	15mg, 30mg, 45mg	Tablet	Y49.2
Trazodone	50mg, 100mg, 150mg, 300mg	Tablet	Y49.2
Venlafaxine	25mg, 37.5mg, 50mg, 75mg, 100mg	Tablet	Y49.2
Venlafaxine, Extended Release	37.5mg, 75mg, 150mg	Capsule	Y49.2

Antidepressants, Serotonin Reuptake Inhibitors
Generic Name(s)	Strength	Dosage Form	ICD Code
Citalopram	10, 20, 40, 10mg/5ml	Tablet, Solution
Escitalopram	10mg, 20mg	Tablet	Y49.2
Escitalopram	5mg/5ml	Solution	Y49.2
Fluoxetine	10mg, 20mg, 40mg	Capsule	Y49.2
Fluoxetine	20mg/5ml	Solution	Y49.2
Fluvoxamine	25mg, 50mg, 100mg	Tablet	Y49.2
Paroxetine	10mg, 20mg, 30mg, 40mg	Tablet	Y49.2
Paroxetine	10mg/5ml	Suspension	Y49.2
Paroxetine	12.5mg, 25mg, 37.5mg	Tablet	Y49.2
Sertraline	25mg, 50mg, 100mg	Tablet	Y49.2
Sertraline	20mg/ml	Oral Conc	Y49.2

Antidepressants, Tricyclic
Generic Name(s)	Strength	Dosage Form	ICD Code
Amitriptyline	10mg, 25mg, 50mg, 75mg, 100mg, 150mg	Tablet	Y49.0
Clomipramine	25mg, 50mg, 75mg	Capsule	Y49.0
Desipramine	10mg, 25mg, 50mg, 75mg, 100mg, 150mg	Tablet	Y49.0
Doxepin	10mg, 25mg, 50mg, 75mg, 100mg, 150mg	Capsule	Y49.0
Doxepin	10mg/ml	Concentrate	Y49.0
Imipramine	10mg, 25mg, 50mg	Tablet	Y49.0
Melitracen	10 mg	Tablet
Nitroxazepine	25mg, 75mg	Tablet	Y49.0
Nortriptyline	10mg/5mg	Solution	Y49.0
Nortriptyline	10mg, 25mg, 50mg, 75mg	Capsule	Y49.0

Antidepressants- Tetracyclic
Generic Name(s)	Strength	Dosage Form	ICD Code
Amoxapine	25 mg, 50 mg, 100 mg, 150 mg	Tablets
Maprotiline			Y49.0
Mianserin	10mg, 30mg	Tablet

Antidepressants- MAOI
Generic Name(s)	Strength	Dosage Form	ICD Code
Isocarboxazid	10mg	Tablets	Y49.1
Moclobemide	150mg, 300mg	Tablet	Y49.1
Phenelzine	15mg	Tablet	Y49.1
Tranylcypromine	10mg	Tablet	Y49.1

Antidepressants- SARI
Generic Name(s)	Strength	Dosage Form	ICD Code
Nefazodone	50mg, 200mg, and 250mg	Tablets	Y49.2

Antidepressants- SNRI
Generic Name(s)	Strength	Dosage Form	ICD Code
Desvenlafaxine	50 and 100 mg	Tablets	Y49.2
Duloxetine	20mg, 30mg, 60mg	Capsules	Y49.2

Antidepressants- SSRI
Generic Name(s)	Strength	Dosage Form	ICD Code
Vilazodone Hydrochloride	10mg, 20mg and 40mg	Tablets	Y49.2

Antimanic Agents
Generic Name(s)	Strength	Dosage Form	ICD Code
Lithium Carbonate	150mg, 300mg, 600mg	Capsule, Tablet
Lithium Carbonate, Sustained Release	300mg, 450mg	Tablet
Lithium Citrate	8mEq/5ml	Syrup

Antipsychotics
Generic Name(s)	Strength	Dosage Form	ICD Code
Amisulpride			Y49.5
Aripiprazole	10mg, 15mg, 20mg, 30mg	Tablet
Asenapine	5-mg, 10-mg	Tablets	Y49.5
Chlorpromazine	10mg, 25mg, 50mg, 100mg, 200mg	Tablet	Y49.5
Chlorpromazine	10mg/5ml, 30mg/ml, 100mg/ml	Syrup	Y49.5
Chlorpromazine	25mg, 100mg	Suppository	Y49.5
Clozapine	25mg, 100mg	Tablet	Y49.5
Filgrastim	300mcg/ml	Vial
Flupenthixol	0.5mg, 1mg,3mg; 20mg/ml	Tablets, Injection
Fluphenazine	1mg, 2.5mg, 5mg, 10mg	Tablet	Y49.5
Fluphenazine	2.5mg/5ml	Elixir	Y49.5
Fluphenazine	5mg/ml	Concentrate	Y49.5
Haloperidol	1mg/ml, 2mg/ml	Solution	Y49.5
Haloperidol	0.5mg, 1mg, 2mg, 5mg, 10mg, 20mg	Tablet	Y49.5
Levosulpiride	75mg	Tablet
Loxapine	5mg, 10mg, 25mg, 50mg	Capsule	Y49.5
Mesoridazine	10mg, 25mg, 50mg, 100mg	Tablet	Y49.3
Mesoridazine	25mg/ml	Oral Conc	Y49.3
Molindone	5mg, 10mg, 25mg, 50mg, 100mg	Tablet	Y49.5
Molindone	20mg/ml	Oral Conc	Y49.5
Olanzapine	2.5mg, 5mg, 7.5mg, 10mg, 15mg	Tablet	Y49.5
Olanzapine	5mg, 10mg, 15mg, 20mg	Tablet	Y49.5
Oprelvekin	5mg	Vial
Paliperidone	1.5mg, 3mg, 6mg, 9mg	Tablets	Y49.5
Pegfilgrastim	6mg/0.6ml	Syringe
Penfluridol	20mg	Tablet
Perphenazine	2mg, 4mg, 8mg, 16mg	Tablet	Y49.3
Perphenazine	16mg/5ml	Oral Conc	Y49.3
Pimozide	2mg	Tablet	Y49.5
Prochlorperazine	5mg, 10mg	Tablet	Y49.3
Prochlorperazine	2.5mg, 5mg, 25mg	Suppository	Y49.3
Prochlorperazine	5mg/5ml	Syrup	Y49.3
Prochlorperazine, Sustained Release	10mg, 15mg	Capsule	Y49.3
Quetiapine	25mg, 100mg, 200mg	Tablet	Y49.5
Risperidone	0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg	Tablet	Y49.5
Risperidone	1mg/ml	Solution	Y49.5
Thioridazine	150mg, 200mg	Tablet	Y49.3
Thioridazine	5mg/ml, 30mg/ml, 100mg/ml	Oral Conc	Y49.3
Thioridazine	25mg/5ml, 100mg/5ml	Suspension	Y49.3
Thiothixene	1mg, 2mg, 5mg, 10mg, 20mg	Capsule	Y49.5
Trifluoperazine	1mg, 2mg, 5mg, 10mg	Tablet	Y49.3
Trifluoperazine	10mg/ml	Oral Conc	Y49.3
Trifluopromazine			Y49.3