Expert Consensus on the Use of Lurasidone for Bipolar I Depression in Asian Patients

​​Eight psychiatrists from Malaysia, Singapore, Taiwan, Hong Kong, and Thailand participated in three meetings using the RAND Corporation/University of California Los Angeles (RAND/UCLA) appropriateness method to establish expert consensus on the use of lurasidone for bipolar I depression in Asian patients. The first meeting generated clinical questions and statements for voting, the second refined these statements, and the third addressed disagreements or areas of uncertainty. Consensus was defined as ≥66% agreement that a statement was appropriate or extremely appropriate. Nearly all proposed statements achieved consensus, including the use of lurasidone as a first-line treatment for first-episode bipolar I depression in adults, with a starting dose of 20 mg/day and titration up to 120 mg/day as needed, as well as its use as adjunctive therapy with mood stabilizers. For elderly patients, a lower dose range of 20-80 mg/day was recommended, while for children and adolescents, a dose range of 20-80 mg/day with careful monitoring was suggested. Lurasidone was considered to have a lower risk of inducing mania or hypomania compared with placebo, conventional antidepressants, and certain antipsychotics, and was associated with a favorable cardiometabolic profile and generally manageable side effects, including nausea, akathisia, and somnolence. Caution was advised when prescribing lurasidone during pregnancy, particularly in the first trimester. This expert consensus provides practical guidance for the use of lurasidone in the treatment of bipolar I depression in Asian patients, complementing existing treatment guidelines and addressing dosing strategies, side effect management, and use in special populations.