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 anticonvulsant-MS vs mood-stabilizer) — class floors may not apply uniformly.
4 drugs selected — Quetiapine, Lurasidone, Lamotrigine, Lithium(click to collapse)
4/4 selected
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)
Lurasidone
Latuda
Second-Generation Antipsychotic
FDA-approved indications
- Schizophrenia (adults; adolescents 13–17 years)
- Bipolar I depression — monotherapy (adults; pediatric 10–17 years)
- Bipolar I depression — adjunct to lithium/valproate (adults)
Off-label uses
- Treatment-resistant depression (adjunct)
- Schizoaffective disorder
Half-life18 hours
Lamotrigine
Lamictal · Subvenite
Anticonvulsant/Mood Stabilizer
FDA-approved indications
- Epilepsy — adjunctive (partial-onset, PGTC, Lennox-Gastaut; 2+ years)
- Epilepsy — conversion to monotherapy (partial-onset; 16+ years)
- Bipolar I maintenance — delay mood episode recurrence (adults)
Off-label uses
- Treatment-resistant depression (unipolar)
- PTSD
- Borderline personality disorder
MechanismAnti-epileptic Agent
Half-life25 hours (14 hours with enzyme inducers; 59 hours with valproate)
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
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
Lurasidone
Consider when
- Metabolic risk prohibits other SGAs — lowest glucose P-score (0.09) in Huhn NMA; favorable weight and lipid profile
- Bipolar depression (mono or adjunct) — FDA-approved for both monotherapy and adjunct to lithium/valproate in bipolar I depression
- QTc prolongation risk — negative QTc point estimate (−1.18 ms Leucht); among safest SGAs for cardiac patients
- Prolactin-sensitive patient — low transient prolactin elevation; favorable vs risperidone/paliperidone
- +1 more
Consider an alternative when
- Inconsistent food intake — must take with ≥350 kcal meal; bioavailability ~3× lower fasting; adherence barrier
- Akathisia is a top priority — highest akathisia RR among SGAs in Huhn 2019 (RR 3.93); leading tolerability concern
- Severe nausea or GI sensitivity — nausea 10% vs 5% placebo; rates rise with dose; may limit titration
- On strong CYP3A4 inhibitor or inducer — contraindicated with strong inhibitors (ketoconazole); dose limits with moderate inhibitors
- +1 more
Lamotrigine
Consider when
- Bipolar depression prevention — strongest evidence among mood stabilizers for preventing depressive relapse; FDA maintenance indication
- Weight-neutral mood stabilizer needed — no significant weight gain; advantage over valproate, lithium, and SGAs
- Bipolar maintenance in women of childbearing potential — lower teratogenicity than valproate; category C vs valproate's D
- Cognitive preservation important — minimal cognitive side effects vs valproate, lithium, or topiramate
- +1 more
Consider an alternative when
- SJS/TEN risk — dose-dependent serious rash; mandatory slow titration over 6+ weeks; risk highest in first 8 weeks
- Rapid mood stabilization needed — 6-week titration to therapeutic dose makes lamotrigine inappropriate for acute episodes
- Acute mania — no evidence for acute antimanic effect; lithium, valproate, or SGAs preferred for acute mania
- On valproate — valproate doubles lamotrigine levels; requires halved dose and even slower titration; complex co-prescribing
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 Interactions2 major4 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 | Quetiapine | Lurasidone | Lamotrigine | Lithium |
|---|---|---|---|---|
| 📊 Efficacy (response rates) | ||||
SchizophreniaEfficacy | — | — | ||
| 🛡️ Acceptability (all-cause discontinuation) | ||||
SchizophreniaAcceptability | — | — | ||
| Axis | Quetiapine SGA | Lurasidone SGA | Lamotrigine anticonvulsant-MS | Lithium mood-stabilizer |
|---|---|---|---|---|
| Boxed Warnings | ||||
Suicidality (boxed warning) | ||||
Agranulocytosis / severe neutropenia | — | — | ||
Cerebrovascular events (elderly w/ dementia) | — | — | ||
Neuroleptic malignant syndrome (NMS) | — | — | ||
DRESS / multiorgan hypersensitivity | — | — | — | |
| 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 | — | — | — | |
| Dermatologic | ||||
Rash (including SJS/TEN, pruritus, hypersensitivity) | — | — | — | |
| Sexual | ||||
Sexual dysfunction | ||||
| Interactions | ||||
Serotonin syndrome risk | — | — | — | |
CYP interactions / DDI profile | — | |||
| Pregnancy | ||||
Teratogenicity | — | — | ||
Lactation / breastfeeding safety | — | — | ||
| Drug-specific / distinctive axes | ||||
Axis 12 — Blood dyscrasias only in Lamotrigine | — | — | — | |
Axis 13 — Hemophagocytic lymphohistiocytosis (HLH) only in Lamotrigine | — | — | — | |
Axis 15 — Aseptic meningitis only in Lamotrigine | — | — | — | |
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 | — | — | — | |