Acadia Pharmaceuticals (NASDAQ:ACAD) aspires to become a big player in the neuroscience market. Eli Lilly (NYSE:LLY) already is one. But aside from their common interest in this therapeutic category, there's little in common between these two drugmakers.

Investors considering buying shares of Acadia or Lilly have a stark contrast -- beaten-down biotech, or relatively boring big pharma. Which stock is the better pick right now? Here's how Acadia Pharmaceuticals and Eli Lilly compare.

Two scientists in a lab side by side

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The case for Acadia Pharmaceuticals

Acadia Pharmaceuticals ranks as one of the worst-performing biotech stocks so far in 2018. Its share price has dropped more than 40% year to date, and that could be perhaps the best argument for buying the stock.

This plunge stems from worries about Acadia's only approved product, Nuplazid (pimavanserin). In April, CNN reported that hundreds of patients who took the antipsychotic drug have experienced serious adverse effects, with Nuplazid listed as a potential factor in at least 500 deaths. A few weeks later, the FDA announced that it was taking another look at the safety profile for the drug

The bullish case for Acadia is that the FDA will stand by its approval decision for Nuplazid in treating Parkinson's disease psychosis with no changes to the product label. If that happens, Acadia stock will likely rebound strongly.

This outcome could also bode well for the biotech's prospects of winning approvals for pimavanserin in additional indications. Acadia is currently evaluating the drug in two late-stage clinical studies targeting the treatment of dementia-related psychosis, and as a schizophrenia inadequate response adjunctive therapy. The company also has phase 2 clinical studies in progress for pimavanserin as a schizophrenia negative symptoms adjunctive therapy and a major depressive disorder adjunctive therapy.

There are at least a couple of reasons to think things could work out for Acadia. First, the FDA itself stated in April that, based on the data that had been examined thus far, no specific safety issues had been identified that aren't already referenced on the product label for Nuplazid. Second, even with the ongoing controversy, the FDA granted approval for a new capsule dose formulation and new tablet strength for the drug just a few weeks ago.

Thanks to Acadia stock's steep decline, the biotech's market cap currently stands at a little over $2 billion. If the safety concerns are addressed and Acadia wins approvals for additional indications, Nuplazid could eventually become a megablockbuster success -- and make the biotech worth a lot more than it's worth today. 

The case for Eli Lilly

Eli Lilly doesn't have nearly as much drama as Acadia. The stock is up by a low single-digit percentage year to date, following a 15% rise last year. This relative stability is one reason investors have liked Lilly for a long time. It has also enabled the big pharma company to pay out an attractive dividend, which currently yields nearly 2.6%.

But income isn't the only thing Eli Lilly offers investors. The company claims several fast-growing drugs in its lineup. At the top of the list is Trulicity, which market research firm EvaluatePharma predicts will become the top-selling diabetes drug in the world within the next few years. Lilly also has three other diabetes drugs with solid sales momentum: Basaglar, Jardiance, and Tradjenta. 

The drugmaker is making a splash in the immunology market as well. Sales for Taltz, which is approved for treating plaque psoriasis and psoriatic arthritis, soared more than 50% year over year in the first quarter. The drug appears to be well on its way to reaching $1 billion in annual sales.

There's also a lot to like in Lilly's pipeline. CEO Dave Ricks stated earlier this year that the company's "next chapter of growth" will be in treating pain. He could be right. Lilly awaits regulatory approval of migraine drug galcanezumab. The pharma company also has great expectations for another migraine drug, lasmiditan, which is in phase 3 clinical testing. In addition, Lilly and Pfizer are evaluating tanezumab in phase 3 studies for treating cancer pain, chronic back pain, and osteoarthritic pain. 

Don't discount Lilly's prospects in oncology, either. The company hopes to win additional approvals for Cyramza in treating bladder cancer, liver cancer, and non-small cell lung cancer. In May, Lilly announced the acquisition of ARMO Biosciences for $1.6 billion. The deal brings several promising immunotherapies into Lilly's pipeline, notably including experimental pancreatic cancer drug AM0010.

Better buy

Acadia Pharmaceuticals could be a huge winner. But that will happen only if the biotech moves past the safety worries about Nuplazid. Lilly faces some risks of its own with sales declining for several of its current top drugs. However, the big drugmaker is a much safer pick than Acadia is right now.

Lilly already has a solid lineup that generates a lot of revenue. It has a pipeline loaded with promising drugs. Acadia has one approved drug that's also the only candidate in its pipeline. Like the old saying goes, a bird in the hand is worth two in the bush. My view is that Lilly is the better choice for investors between these two stocks.

Do I think Lilly is a stock to go out and buy right now? No. In my opinion, there are too many other stocks with better growth prospects and better dividends. Lilly isn't a bad stock, but it's certainly not the best. 

Keith Speights owns shares of Pfizer. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.