OBJECTIVES: Patient focus groups were conducted to identify the most important clinical attributes and outcomes of pharmacological treatments for bipolar depression influencing patients’ treatment adherence decisions. Qualitative results will guide the development of a quantitative discrete choice experiment to determine patient preferences and willingness to trade-off between medication characteristics. METHODS: Adults clinically diagnosed with bipolar I disorder, recently depressed, previously/currently treated with antipsychotics, and not currently suicidal were recruited from two clinical sites. Following an IRB-approved (E&I Review Services) protocol, inclusion criteria, and semi-structured, open-ended discussion guide, focus groups lasting 90-minutes were conducted to discuss patients’ expectations and experiences towards treatment safety and efficacy. Focus groups recordings were transcribed, a data coding dictionary developed, and ATLAS.ti used for qualitative data analysis. RESULTS: From the two focus groups conducted (n=8 each; Total N=16; mean age 47.9±6.4 years; 68.8% female, mean time since diagnosis 15.7±11.4 years; mean length of atypical antipsychotic use 4.7±4.6 years), participants were most concerned with treatment efficacy, expecting a medication to balance the “highs and lows” of bipolar symptoms and providing “clarity” (control of thoughts and actions). One in 4  expected symptom improvements within 2-3 weeks of treatment initiation, and would tolerate side effects and less desirable features, as long as these did not outweigh treatment benefits. Side effects mentioned spontaneously and rated most highly by participants as influencing treatment initiation and persistence decisions were weight gain (n=8, 50.0%) and sedation/fatigue (n=7, 43.8%). To manage side effects, most (n=7, 43.8%) reported self-treatment by reducing dosage or discontinuing without medical consultation. CONCLUSIONS: Treatment efficacy, faster onset in terms of  symptom improvement, less weight gain, and less severe sedation/fatigue were identified as most important outcomes determining patients’ treatment decisions. Based on qualitative results, identified treatment attributes will be included in a quantitative discrete choice experiment to determine patients’ preferences for bipolar depression pharmacological treatments.