ReviewEfficacy and safety profiles of mood stabilizers and antipsychotics for bipolar depression: a systematic reviewCai, Luyaoa,*; Chen, Guanjieb,*; Yang, Haichena; Bai, Yuanhana Author Information aDepartment of Bipolar Disorder bTeaching Management Office, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China Received 16 July 2022 Accepted 8 November 2022. *Luyao Cai and Guanjie Chen contributed equally to the writing of this article. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.intclinpsychopharm.com. Correspondence to Yuanhan Bai, MD, MS, Department of Bipolar Disorder, Shenzhen Kangning Hospital, 77 Zhenbi Road, Pingshan District, Shenzhen 518118, China, Tel: +8613530242339; e-mail: [email protected] International Clinical Psychopharmacology 38(4):p 249-260, July 2023. | DOI: 10.1097/YIC.0000000000000449 Buy SDC Metrics Abstract The whole picture of psychotropics for bipolar depression (BPD) remains unclear. This review compares the differences in efficacy and safety profiles among common psychotropics for BPD. MEDLINE, EMBASE, and PsycINFO were searched for proper studies. The changes in the depressive rating scale, remission/response rates, nervous system adverse events (NSAEs), gastrointestinal adverse events (GIAEs), metabolic parameters, and prolactin were compared between medication and placebo or among medications with the Cohen’s d or number needed to treat/harm. The search provided 10 psychotropics for comparison. Atypical antipsychotics (AAPs) were superior to lithium and lamotrigine at alleviating acute depressive symptoms. Lithium was more likely to induce dry mouth and nausea. Cariprazine and aripiprazole seemed to be associated with an increased risk of akathisia and upper GIAEs. Lurasidone was associated with an increased risk of developing akathisia and hyperprolactinemia. Olanzapine, olanzapine–fluoxetine combination (OFC), and quetiapine were associated with an increased risk of NSAEs, metabolic risk, dry mouth, and constipation. Cariprazine, lurasidone, OFC, or quetiapine was optimal monotherapy for BPD. Further studies are needed to assess the efficacy and safety of lamotrigine for treating BPD. Adverse events varied widely across different drug types due to variations in psychopharmacological mechanisms, dosages, titration, and ethnicities. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.