Background <p>Mental illness is common, and a sizeable number of individuals who are prescribed medication remain at work. This presents a growing and salient concern, particularly in cases where the bona fide occupational requirements are safety-sensitive or decision-critical in nature. Currently, there exists no framework in Canada that guides and assists practitioners and other stakeholders in navigating the impact of psychiatric medications and the underlying disorders in occupational settings. </p> Methods <p>A review was conducted to gather information on relevant psychiatric medications and underlying diagnoses, to construct pragmatic guidance to stakeholders in safety-sensitive and decision-critical contexts.</p> Results <p>This review offers a 6-step approach to navigating psychiatric medication use to allow for achieving a balance between a worker’s maximum medical improvement and mitigating occupational risk: Step 1: Does the underlying psychiatric diagnosis impact workability? Step 2: Assess the medication’s likely occupationally relevant side-effects. Step 3: Determine if the medication used should be indefinitely restricted in safety-sensitive or decision-critical settings. Step 4: Determine if the medication used should be temporarily restricted in safety-sensitive and decision-critical settings. Step 5: Should shift restrictions apply? Step 6: Consider appropriate modification of workplace duties and the need for other accommodations.</p> Conclusion <p>Limitations notwithstanding, this approach offers a pragmatic framework for navigating psychiatric medication use in safety-sensitive and decision-critical occupations, where impairment, either medication- or diagnosis-related, can result in serious consequences.</p>