Controversies in bipolar disorder; role of second-generation antipsychotic for maintenance therapy

Jauhar, Sameer; Young, Allan H.

doi:10.1186/s40345-019-0145-0

International Journal of Bipolar Disorders

Table 1 Polarity, receptor affinities and side-effects of antipsychotics used in the maintenance treatment of bipolar disorder

From: Controversies in bipolar disorder; role of second-generation antipsychotic for maintenance therapy

Antipsychotic	Polarity^a	Receptor profile in order of affinity^b	Common side effects^b
Aripiprazole	Mania, mixed features	D₂ partial agonist 5HT_2A antagonist 5HT_1A partial agonist 5HT₇ antagonist 5HT_2C partial agonist α₂ antagonist	Akathisia, headache, nausea
Asenapine	Mania/mixed features, depression	5HT_2c antagonist 5HT_2a antagonist 5HT₇ antagonist 5HT_2b antagonist 5HT₆ antagonist 5HT₇ α_2B antagonist D₃ antagonist H₁ antagonist α₁ antagonist α_2A antagonist α_2C antagonist D₂ antagonist D₁ antagonist 5 HT_5a antagonist 5 HT_1a partial agonist H₂ antagonist α₁ antagonist	Sedation, EPSEs, postural hypotension
Cariprazine	Mania/mixed features	D₃ partial agonist D₂ partial agonist 5HT_2B antagonist 5HT_1A partial agonist 5HT_2A antagonist H₁ antagonist 5HT₇ antagonist 5HT_2C antagonist α _1A antagonist	Akathisia, EPSEs, nausea
Lurasidone	Mania/mixed features, depression	5HT₇ antagonist D₂ antagonist 5HT_2Aantagonist 5HT_1Aantagonist α₂ antagonist	EPSEs, sedation
Olanzapine	Mania/mixed features, depression^c	H₁ antagonist 5HT_2A antagonist 5HT_2C inverse agonist D₂ antagonist M₁-M₅ antagonist	Sedation, weight gain, dyslipidaemia
Quetiapine	Mania/mixed features, depression	H₁ antagonist α_1A antagonist α_2C antagonist α_1B antagonist α_2B antagonist 5HT_2A antagonist D₂ antagonist 5HT₇ antagonist Norquetiapine (metabolite of quetiapine) H₁ antagonist 5HT_2B antagonist M₃ antagonist M₅ antagonist M₁ antagonist 5HT_1A partial agonist 5HT_2A antagonist NET inhibitor α₁ antagonist D₂ antagonist (higher doses)	Sedation, weight gain, postural hypotension
Risperidone	Mania	5HT_2A inverse agonist D₂ antagonist 5HT₇ antagonist α₁ antagonist 5HT_2C inverse agonist H₁ antagonist α₂ antagonist	EPSEs, weight gain, elevated prolactin, postural hypotension

^aBased on RCT and meta-analytic evidence in text, above
^bAdapted from Maudsley Psychosis Prescribing Guidelines
^cEffective in depression in combination with fluoxetrine

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