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Clinical relevance of treatments for acute bipolar disorder: balancing therapeutic and adverse effects.
Clin Ther. 2011 Dec; 33(12):B40-8.CT

Abstract

BACKGROUND

The US Food and Drug Administration (FDA) has approved 10 treatments for acute mania, but only 2 for acute bipolar depression. These agents differ from one another with respect to their efficacy and tolerability profiles, such that certain medications may be optimal for some patients but not others.

OBJECTIVE

Our aim was to compare the therapeutic and adverse effects of treatments for acute mania and acute bipolar depression to inform clinical decision making.

METHODS

Using data from large, randomized, double-blind, placebo-controlled acute mania and acute bipolar depression trials, we assessed number needed to treat (NNT) for response, number needed to harm (NNH) for sedation/weight gain, and likelihood to help or harm (LHH = NNH ÷ NNT) compared with placebo.

RESULTS

For acute mania, lithium compared with other FDA-approved agents yielded substantively less sedation (NNH, 27 vs 5-17) yet broadly similar efficacy (NNT, 4 vs 4-8), and thus a more favorable efficacy:sedation likelihood (LHH, 6.8 vs 0.7-3.4). For acute bipolar depression, lamotrigine compared with FDA-approved treatments yielded substantively less sedation (NNH, 42 vs 6-12), weight gain (NNH, -34 vs 6-19), and efficacy (NNT, 12 vs 4-6), but still more favorable efficacy:sedation likelihood (LHH, 3.5) than quetiapine (LHH, 1.0) and efficacy:weight gain likelihood (LHH, -2.8) than the olanzapine plus fluoxetine combination (LHH, 1.5).

CONCLUSIONS

For acute mania, lithium compared with other FDA-approved agents yielded less sedation yet similar efficacy, indicating utility for patients sensitive to sedation. For acute bipolar depression, lamotrigine compared with FDA-approved treatments yielded better tolerability but poorer efficacy, suggesting utility in patients sensitive to sedation/weight gain with milder episodes, whereas the FDA-approved treatments might have utility in patients with more severe episodes.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

22177379

Citation

Srivastava, Shefali, and Terence A. Ketter. "Clinical Relevance of Treatments for Acute Bipolar Disorder: Balancing Therapeutic and Adverse Effects." Clinical Therapeutics, vol. 33, no. 12, 2011, pp. B40-8.
Srivastava S, Ketter TA. Clinical relevance of treatments for acute bipolar disorder: balancing therapeutic and adverse effects. Clin Ther. 2011;33(12):B40-8.
Srivastava, S., & Ketter, T. A. (2011). Clinical relevance of treatments for acute bipolar disorder: balancing therapeutic and adverse effects. Clinical Therapeutics, 33(12), B40-8. https://doi.org/10.1016/j.clinthera.2011.11.020
Srivastava S, Ketter TA. Clinical Relevance of Treatments for Acute Bipolar Disorder: Balancing Therapeutic and Adverse Effects. Clin Ther. 2011;33(12):B40-8. PubMed PMID: 22177379.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical relevance of treatments for acute bipolar disorder: balancing therapeutic and adverse effects. AU - Srivastava,Shefali, AU - Ketter,Terence A, PY - 2011/09/14/received PY - 2011/11/10/revised PY - 2011/11/11/accepted PY - 2011/12/20/entrez PY - 2011/12/20/pubmed PY - 2012/4/14/medline SP - B40 EP - 8 JF - Clinical therapeutics JO - Clin Ther VL - 33 IS - 12 N2 - BACKGROUND: The US Food and Drug Administration (FDA) has approved 10 treatments for acute mania, but only 2 for acute bipolar depression. These agents differ from one another with respect to their efficacy and tolerability profiles, such that certain medications may be optimal for some patients but not others. OBJECTIVE: Our aim was to compare the therapeutic and adverse effects of treatments for acute mania and acute bipolar depression to inform clinical decision making. METHODS: Using data from large, randomized, double-blind, placebo-controlled acute mania and acute bipolar depression trials, we assessed number needed to treat (NNT) for response, number needed to harm (NNH) for sedation/weight gain, and likelihood to help or harm (LHH = NNH ÷ NNT) compared with placebo. RESULTS: For acute mania, lithium compared with other FDA-approved agents yielded substantively less sedation (NNH, 27 vs 5-17) yet broadly similar efficacy (NNT, 4 vs 4-8), and thus a more favorable efficacy:sedation likelihood (LHH, 6.8 vs 0.7-3.4). For acute bipolar depression, lamotrigine compared with FDA-approved treatments yielded substantively less sedation (NNH, 42 vs 6-12), weight gain (NNH, -34 vs 6-19), and efficacy (NNT, 12 vs 4-6), but still more favorable efficacy:sedation likelihood (LHH, 3.5) than quetiapine (LHH, 1.0) and efficacy:weight gain likelihood (LHH, -2.8) than the olanzapine plus fluoxetine combination (LHH, 1.5). CONCLUSIONS: For acute mania, lithium compared with other FDA-approved agents yielded less sedation yet similar efficacy, indicating utility for patients sensitive to sedation. For acute bipolar depression, lamotrigine compared with FDA-approved treatments yielded better tolerability but poorer efficacy, suggesting utility in patients sensitive to sedation/weight gain with milder episodes, whereas the FDA-approved treatments might have utility in patients with more severe episodes. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/22177379/Clinical_relevance_of_treatments_for_acute_bipolar_disorder:_balancing_therapeutic_and_adverse_effects_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(11)00771-5 DB - PRIME DP - Unbound Medicine ER -