Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
⚠ Cross-class comparison (SGA vs mood-stabilizer) — class floors may not apply uniformly.
4 drugs selected — Aripiprazole, Brexpiprazole, Quetiapine, Lithium(click to collapse)
4/4 selected
Aripiprazole
Abilify
Second-Generation Antipsychotic (Partial D2 Agonist)
FDA-approved indications
- Schizophrenia (adults; adolescents 13+)
- Irritability associated with autistic disorder (6–17 years)
- Tourette's disorder (6–18 years)
Off-label uses
- Bipolar depression (adjunct)
- Tic disorders
- Agitation in dementia
MechanismAtypical Antipsychotic
Half-life75 hours (dehydro-aripiprazole: 94 hours)
Brexpiprazole
Rexulti
Second-Generation Antipsychotic (Partial D2 Agonist)
FDA-approved indications
- Schizophrenia (adults; adolescents 13+)
- MDD — adjunct to antidepressants (adults)
- Agitation associated with Alzheimer's dementia (adults)
Off-label uses
- PTSD (adjunct)
- Bipolar disorder
MechanismAtypical Antipsychotic
Half-life91 hours
Quetiapine
Seroquel
Second-Generation Antipsychotic
FDA-approved indications
- Schizophrenia (adults; adolescents 13–17 years)
- Acute mania in Bipolar I — mono or adjunct to lithium/divalproex
- Bipolar depression (adults)
- Bipolar I maintenance — adjunct to lithium/divalproex (adults)
Off-label uses
- Insomnia
- Generalized anxiety disorder
- PTSD
Half-life~7 hours (norquetiapine active metabolite: ~12 hours)
Lithium
Lithobid
Mood Stabilizer
FDA-approved indications
- Bipolar I — acute manic and mixed episodes (7+ years; monotherapy)
- Bipolar I — maintenance treatment (7+ years; monotherapy)
Off-label uses
- Cluster headache prophylaxis
- Augmentation of antidepressants in MDD
- Aggression/self-harm
Half-life18 to 36 hours
Decision GuideWhen to pick each / when to consider an alternative
Aripiprazole
Consider when
- Hyperprolactinemia concern — only SGA that lowers prolactin; can reverse galactorrhea/amenorrhea from prior antipsychotic
- Metabolic-sparing antipsychotic needed — lowest BMI change (+0.22 kg/m²) and near-placebo glucose/lipid effects in Huhn 2019 NMA
- Pediatric autism irritability (6–17) or Tourette disorder — FDA-approved both; one of only two SGAs with pediatric autism indication
- LAI for long-term adherence — monthly Maintena or 2-monthly Asimtufii; broadest LAI option set among partial agonists
- +1 more
Consider an alternative when
- History of pathological gambling, hypersexuality, or impulse-control disorder — partial D2 agonism carries unique compulsive behavior risk
- Akathisia is poorly tolerated — Huhn 2019 RR ~1.95 (mid-to-high among SGAs); akathisia is leading discontinuation cause
- Restlessness, insomnia, or anxiety worsens with activation — partial-agonist activation profile worse than quetiapine/olanzapine
- Severe acute psychosis requiring rapid sedation — partial agonist may have slower onset; olanzapine IM or haloperidol IM preferred
- +1 more
Brexpiprazole
Consider when
- MDD adjunct with akathisia sensitivity — lower akathisia than aripiprazole (RR 1.35 NS vs 1.95); better tolerated as AD augmentation
- Alzheimer's disease agitation — only SGA with FDA approval for agitation in Alzheimer's dementia
- Prolactin sensitivity — partial D2 agonist with near-placebo prolactin elevation; avoids galactorrhea/amenorrhea
- QTc or anticholinergic burden constraint — negative QTc effect (−1.48 ms) and below-placebo anticholinergic profile
- +1 more
Consider an alternative when
- Acute psychosis or severe agitation requiring rapid response — partial agonist with gradual onset; may be insufficient acutely
- Cost or formulary constraint — brand-only with no generic; significant premium over aripiprazole generics
- On potent CYP2D6 or CYP3A4 inhibitors — dose halving required; fluoxetine, paroxetine, or ketoconazole combinations need adjustment
- On strong CYP3A4 inducer (carbamazepine, phenytoin, rifampin) — dose doubling required per label
- +1 more
Quetiapine
Consider when
- Bipolar depression — only SGA FDA-approved as monotherapy for bipolar I and II depression (not just mania)
- Motor-sensitive patient or EPS history — lowest EPS risk among SGAs (akathisia RR 1.01, antiparkinson OR 0.94)
- Parkinson disease or Lewy body dementia psychosis — lowest EPS makes it preferred SGA in movement disorder populations
- Sedation is therapeutically beneficial — dose-stratified H1 blockade; low-dose XR useful for insomnia/anxiety augmentation
- +1 more
Consider an alternative when
- Driving, machinery, or high-attention occupation — significant next-day somnolence impairs psychomotor performance
- History of cataracts or active eye disease — quetiapine-distinctive FDA-labeled cataract warning; periodic slit-lamp exams recommended
- Cardiometabolic risk — second-tier weight gain (~2–3 kg short-term); metabolic monitoring required
- Substance use disorder with sedative misuse pattern — documented quetiapine misuse for sedation/euphoria in SUD populations
- +1 more
Lithium
Consider when
- Bipolar mania — gold standard mood stabilizer with 60+ years of evidence; FDA-approved for acute mania and maintenance
- Anti-suicide benefit — only psychiatric medication with replicated evidence for reducing suicide risk across bipolar and MDD
- Bipolar maintenance preventing both mania and depression — strongest long-term relapse prevention data of any mood stabilizer
- Treatment-resistant depression augmentation — FDA-supported augmentation strategy; effective with SSRIs, SNRIs, and TCAs
- +1 more
Consider an alternative when
- Renal disease or progressive renal impairment — narrow therapeutic index with 95% renal excretion; nephrotoxicity cumulative
- Thyroid disease — dose-dependent hypothyroidism in 20–30% of patients; requires ongoing TSH monitoring
- Unreliable hydration or sodium intake — dehydration, low-sodium diets, and NSAIDs/ACEIs/ARBs precipitate toxicity
- Teratogenicity concern — Ebstein's anomaly risk (0.1–0.2%); cardiac ultrasound required if first-trimester exposure
- +1 more
Drug-Drug Interactions3 major3 moderate
Educational reference only. Interactions are extracted from FDA prescribing information and DDInter 2.0. Always verify with institutional pharmacy systems before clinical decisions.
Efficacy & Acceptability (2 axes)— NMA efficacy & discontinuation data (not side effects)
| Axis | Aripiprazole | Brexpiprazole | Quetiapine | Lithium |
|---|---|---|---|---|
| 📊 Efficacy (response rates) | ||||
SchizophreniaEfficacy | — | |||
| 🛡️ Acceptability (all-cause discontinuation) | ||||
SchizophreniaAcceptability | — | |||
| Axis | Aripiprazole SGA | Brexpiprazole SGA | Quetiapine SGA | Lithium mood-stabilizer |
|---|---|---|---|---|
| Boxed Warnings | ||||
Suicidality (boxed warning) | ||||
Agranulocytosis / severe neutropenia | — | |||
Cerebrovascular events (elderly w/ dementia) | — | |||
Impulse-control / pathological gambling | — | — | — | |
Neuroleptic malignant syndrome (NMS) | — | |||
| CNS | ||||
Sedation / somnolence | ||||
Activation / insomnia | ||||
Akathisia / EPS | — | — | ||
Tardive dyskinesia | — | |||
Seizure risk | ||||
Cognitive dulling / anterograde amnesia | — | — | — | |
| Metabolic | ||||
Weight gain | ||||
Metabolic (glucose / lipids) | ||||
| Endocrine | ||||
Prolactin elevation | — | |||
Renal effects | — | — | — | |
| Autonomic | ||||
Anticholinergic burden | — | |||
Orthostatic hypotension | — | |||
Sweating | — | — | — | |
| Sensory | ||||
Visual disturbances (blurred vision, diplopia, lens changes) | — | — | — | |
| Cardiac | ||||
QTc prolongation | — | |||
Cardiac conduction / AV block | — | — | — | |
Blood pressure elevation | — | — | — | |
Heart rate / tachycardia | — | — | — | |
| GI | ||||
Nausea / GI (general) | ||||
| Hepatic | ||||
Liver enzymes / hepatotoxicity | — | — | — | |
| Sexual | ||||
Sexual dysfunction | ||||
| Interactions | ||||
Serotonin syndrome risk | — | — | — | |
CYP interactions / DDI profile | — | |||
| Pregnancy | ||||
Teratogenicity | — | — | — | |
Lactation / breastfeeding safety | — | |||
| Drug-specific / distinctive axes | ||||
Lithium toxicity (BOXED — narrow therapeutic index) only in Lithium | — | — | — | |
Thyroid (hypothyroidism > hyperthyroidism) only in Lithium | — | — | — | |
Hypercalcemia / hyperparathyroidism (distinctive) only in Lithium | — | — | — | |
Encephalopathic syndrome (lithium + neuroleptic) only in Lithium | — | — | — | |
Pseudotumor cerebri only in Lithium | — | — | — | |