Newer antipsychotics promise novel mechanisms and fewer metabolic headaches, but the pediatric data have not caught up with the enthusiasm. This update cuts through the excitement around lumateperone, xanomeline-trospium, and TAAR1 agonists, and offers a practical framework for deciding when, if ever, to venture beyond the tried-and-true SGAs.

A new placebo-controlled trial suggests lumateperone rapidly improves depressive and manic symptoms in mixed features—with minimal metabolic or EPS burden.

With numerous treatment options available for bipolar depression and mania, clinicians often struggle to navigate between medication classes in balancing side effects, efficacy, and costs. Dr. Beyer shares his expertise in choosing first-, second-, third-, and fourth-line options based on their evidence in older adults.