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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 Polaritya Receptor profile in order of affinityb Common side effectsb
Aripiprazole Mania, mixed features D2 partial agonist
5HT2A antagonist
5HT1A partial agonist
5HT7 antagonist
5HT2C partial agonist
α2 antagonist
Akathisia, headache, nausea
Asenapine Mania/mixed features, depression 5HT2c antagonist
5HT2a antagonist
5HT7 antagonist
5HT2b antagonist
5HT6 antagonist
5HT7 α2B antagonist
D3 antagonist
H1 antagonist
α1 antagonist
α2A antagonist
α2C antagonist
D2 antagonist
D1 antagonist
5 HT5a antagonist
5 HT1a partial agonist
H2 antagonist
α1 antagonist
Sedation, EPSEs, postural hypotension
Cariprazine Mania/mixed features D3 partial agonist
D2 partial agonist
5HT2B antagonist
5HT1A partial agonist
5HT2A antagonist
H1 antagonist
5HT7 antagonist
5HT2C antagonist
α 1A antagonist
Akathisia, EPSEs, nausea
Lurasidone Mania/mixed features, depression 5HT7 antagonist
D2 antagonist
5HT2Aantagonist
5HT1Aantagonist
α2 antagonist
EPSEs, sedation
Olanzapine Mania/mixed features, depressionc H1 antagonist
5HT2A antagonist
5HT2C inverse agonist
D2 antagonist
M1-M5 antagonist
Sedation, weight gain, dyslipidaemia
Quetiapine Mania/mixed features, depression H1 antagonist
α1A antagonist
α2C antagonist
α1B antagonist
α2B antagonist
5HT2A antagonist
D2 antagonist
5HT7 antagonist
Norquetiapine (metabolite of quetiapine)
H1 antagonist
5HT2B antagonist
M3 antagonist
M5 antagonist
M1 antagonist
5HT1A partial agonist
5HT2A antagonist
NET inhibitor
α1 antagonist
D2 antagonist (higher doses)
Sedation, weight gain, postural hypotension
Risperidone Mania 5HT2A inverse agonist
D2 antagonist
5HT7 antagonist
α1 antagonist
5HT2C inverse agonist
H1 antagonist
α2 antagonist
EPSEs, weight gain, elevated prolactin, postural hypotension
  1. aBased on RCT and meta-analytic evidence in text, above
  2. bAdapted from Maudsley Psychosis Prescribing Guidelines
  3. cEffective in depression in combination with fluoxetrine