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Comparative efficacy and acceptability of drug treatments for bipolar depression: a multiple-treatments meta-analysis.
Acta Psychiatr Scand. 2014 Dec; 130(6):452-69.AP

Abstract

OBJECTIVE

Treatment of bipolar depression is complicated by variable response and risk of switch to mania. Guidance is informed by the strength of evidence rather than by comparative data.

METHOD

We performed a multiple-treatments meta-analysis of randomised, double-blind, controlled comparisons of 4-16 weeks in adults in bipolar depression. The primary efficacy outcome was effect size. The primary acceptability outcome was 'switch to mania'. Secondary outcomes were likelihood of response and withdrawals from trials.

RESULTS

Twenty-nine studies were included (8331 participants). Olanzapine + fluoxetine and olanzapine performed best on primary outcome measure being ranked highest for effect size. Switch to mania was least likely with ziprasidone and then quetiapine. Olanzapine + fluoxetine was also ranked the highest for response with lurasidone second, but olanzapine + fluoxetine and olanzapine had the optimal effect on response and withdrawal from treatment when the two parameters were considered together. Several treatments [monoamine oxidase inhibitors (MAOIs), ziprasidone, aripiprazole and risperidone] have limited or no therapeutic activity in bipolar depression.

CONCLUSION

Olanzapine + fluoxetine should be first-line treatment. Olanzapine, quetiapine, lurasidone, valproate and selective serotonin re-uptake inhibitors are also recommended. Tricyclic antidepressants and lithium are worthy of consideration but lamotrigine (high risk of switching, less robust efficacy) and MAOIs, ziprasidone, aripiprazole and risperidone (no evidence of efficacy) should not be used.

Authors+Show Affiliations

Pharmacy Department, Maudsley Hospital, Denmark Hill, London, UK; Institute of Pharmaceutical Science, King's College London, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

25283309

Citation

Taylor, D M., et al. "Comparative Efficacy and Acceptability of Drug Treatments for Bipolar Depression: a Multiple-treatments Meta-analysis." Acta Psychiatrica Scandinavica, vol. 130, no. 6, 2014, pp. 452-69.
Taylor DM, Cornelius V, Smith L, et al. Comparative efficacy and acceptability of drug treatments for bipolar depression: a multiple-treatments meta-analysis. Acta Psychiatr Scand. 2014;130(6):452-69.
Taylor, D. M., Cornelius, V., Smith, L., & Young, A. H. (2014). Comparative efficacy and acceptability of drug treatments for bipolar depression: a multiple-treatments meta-analysis. Acta Psychiatrica Scandinavica, 130(6), 452-69. https://doi.org/10.1111/acps.12343
Taylor DM, et al. Comparative Efficacy and Acceptability of Drug Treatments for Bipolar Depression: a Multiple-treatments Meta-analysis. Acta Psychiatr Scand. 2014;130(6):452-69. PubMed PMID: 25283309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative efficacy and acceptability of drug treatments for bipolar depression: a multiple-treatments meta-analysis. AU - Taylor,D M, AU - Cornelius,V, AU - Smith,L, AU - Young,A H, Y1 - 2014/10/06/ PY - 2014/09/09/accepted PY - 2014/10/7/entrez PY - 2014/10/7/pubmed PY - 2015/7/15/medline KW - antidepressives KW - antipsychotics KW - bipolar disorder KW - depression SP - 452 EP - 69 JF - Acta psychiatrica Scandinavica JO - Acta Psychiatr Scand VL - 130 IS - 6 N2 - OBJECTIVE: Treatment of bipolar depression is complicated by variable response and risk of switch to mania. Guidance is informed by the strength of evidence rather than by comparative data. METHOD: We performed a multiple-treatments meta-analysis of randomised, double-blind, controlled comparisons of 4-16 weeks in adults in bipolar depression. The primary efficacy outcome was effect size. The primary acceptability outcome was 'switch to mania'. Secondary outcomes were likelihood of response and withdrawals from trials. RESULTS: Twenty-nine studies were included (8331 participants). Olanzapine + fluoxetine and olanzapine performed best on primary outcome measure being ranked highest for effect size. Switch to mania was least likely with ziprasidone and then quetiapine. Olanzapine + fluoxetine was also ranked the highest for response with lurasidone second, but olanzapine + fluoxetine and olanzapine had the optimal effect on response and withdrawal from treatment when the two parameters were considered together. Several treatments [monoamine oxidase inhibitors (MAOIs), ziprasidone, aripiprazole and risperidone] have limited or no therapeutic activity in bipolar depression. CONCLUSION: Olanzapine + fluoxetine should be first-line treatment. Olanzapine, quetiapine, lurasidone, valproate and selective serotonin re-uptake inhibitors are also recommended. Tricyclic antidepressants and lithium are worthy of consideration but lamotrigine (high risk of switching, less robust efficacy) and MAOIs, ziprasidone, aripiprazole and risperidone (no evidence of efficacy) should not be used. SN - 1600-0447 UR - https://www.unboundmedicine.com/medline/citation/25283309/Comparative_efficacy_and_acceptability_of_drug_treatments_for_bipolar_depression:_a_multiple_treatments_meta_analysis_ L2 - https://doi.org/10.1111/acps.12343 DB - PRIME DP - Unbound Medicine ER -