Psychotic features are common in bipolar disorder (BD), especially during acute mania. Even when early detected, their long-term management is difficult, essentially due to the unsatisfactory efficacy/tolerability profile of currently available treatments, thus soliciting the development of novel experimental drugs. Areas covered: Potential drug targets towards the development of experimental drugs in the treatment of bipolar psychosis are yet to be systematically characterized. Among other potential avenues, the kynurenic acid pathway may represent an intriguing opportunity. Safer lithium alternatives should also be investigated in bipolar psychosis models. Expert opinion: Regardless of the neurobiological pathways potentially worthy of investigation towards the development of experimental drugs in the treatment of bipolar psychosis, a number of unmet needs should be addressed. Primary goals of novel experimental drugs should be a better metabolic and cognitive tolerability profile, ultimately aiming to reduce the burden of acute psychotic mania and BD overall.
Keywords: Experimental drugs; bipolar disorder; cognitive tolerability; long-term management; metabolic tolerability; neuroprotection; psychosis.