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Efficacy and tolerability of treatments for bipolar depression.
J Affect Disord. 2015 Sep 01; 183:258-62.JA

Abstract

BACKGROUND

Depression in bipolar disorder is a major therapeutic challenge associated with disability and excess mortality.

METHODS

We reviewed findings from randomized placebo-controlled trials concerning efficacy and adverse effects of treatments for acute bipolar depression, including anticonvulsants, antidepressants, lithium, and modern antipsychotics, to compare numbers-needed-to-treat (NNT) versus -to-harm (NNH).

RESULTS

Included were data from 22 reports involving 33 drug-placebo pairs. Antidepressants (especially modern drugs) had the most favorable (highest) risk/benefit ratio (pooled NNH/NNT=18.1). Anticonvulsants were effective agents (pooled NNT=5.06), but carbamazepine and valproate were not as well tolerated (NNH<10) as lamotrigine, and they had an unfavorable pooled NNH/NNT (3.75). Some antipsychotics (lurasidone, olanzapine+fluoxetine, and quetiapine (NNT all < 10) were effective though aripiprazole and ziprasidone were not (NNT≥45); olanzapine alone was weakly effective (NNT=11.3), and all but lurasidone (NNH=20.2) were not well tolerated (NNH≤4.18). Lithium appeared to be poorly effective but well tolerated in only one trial.

CONCLUSIONS

Some anticonvulsants and antipsychotics seemed effective for acute bipolar depression, but most antipsychotics were not well tolerated. Antidepressants were effective and well-tolerated; lithium remains inadequately tested.

LIMITATIONS

There are remarkably few short-term treatment trials (2.75/12 treatments), and fewer long-term trials for bipolar depression, possibly arising from exaggerated concerns about inducing mania.

Authors+Show Affiliations

International Consortium for Bipolar and Psychotic Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Neuroscience, Palermo University, Buenos Aires, Argentina. Electronic address: gvazquez@palermo.edu.Department of Neuroscience, Palermo University, Buenos Aires, Argentina; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.International Consortium for Bipolar and Psychotic Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy.International Consortium for Bipolar and Psychotic Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26042634

Citation

Vázquez, Gustavo H., et al. "Efficacy and Tolerability of Treatments for Bipolar Depression." Journal of Affective Disorders, vol. 183, 2015, pp. 258-62.
Vázquez GH, Holtzman JN, Tondo L, et al. Efficacy and tolerability of treatments for bipolar depression. J Affect Disord. 2015;183:258-62.
Vázquez, G. H., Holtzman, J. N., Tondo, L., & Baldessarini, R. J. (2015). Efficacy and tolerability of treatments for bipolar depression. Journal of Affective Disorders, 183, 258-62. https://doi.org/10.1016/j.jad.2015.05.016
Vázquez GH, et al. Efficacy and Tolerability of Treatments for Bipolar Depression. J Affect Disord. 2015 Sep 1;183:258-62. PubMed PMID: 26042634.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and tolerability of treatments for bipolar depression. AU - Vázquez,Gustavo H, AU - Holtzman,Jessica N, AU - Tondo,Leonardo, AU - Baldessarini,Ross J, Y1 - 2015/05/19/ PY - 2015/02/26/received PY - 2015/04/06/revised PY - 2015/05/07/accepted PY - 2015/6/5/entrez PY - 2015/6/5/pubmed PY - 2016/1/13/medline KW - Bipolar depression KW - Number-needed-to-harm (NNH) KW - Number-needed-to-treat (NNT) KW - Treatments SP - 258 EP - 62 JF - Journal of affective disorders JO - J Affect Disord VL - 183 N2 - BACKGROUND: Depression in bipolar disorder is a major therapeutic challenge associated with disability and excess mortality. METHODS: We reviewed findings from randomized placebo-controlled trials concerning efficacy and adverse effects of treatments for acute bipolar depression, including anticonvulsants, antidepressants, lithium, and modern antipsychotics, to compare numbers-needed-to-treat (NNT) versus -to-harm (NNH). RESULTS: Included were data from 22 reports involving 33 drug-placebo pairs. Antidepressants (especially modern drugs) had the most favorable (highest) risk/benefit ratio (pooled NNH/NNT=18.1). Anticonvulsants were effective agents (pooled NNT=5.06), but carbamazepine and valproate were not as well tolerated (NNH<10) as lamotrigine, and they had an unfavorable pooled NNH/NNT (3.75). Some antipsychotics (lurasidone, olanzapine+fluoxetine, and quetiapine (NNT all < 10) were effective though aripiprazole and ziprasidone were not (NNT≥45); olanzapine alone was weakly effective (NNT=11.3), and all but lurasidone (NNH=20.2) were not well tolerated (NNH≤4.18). Lithium appeared to be poorly effective but well tolerated in only one trial. CONCLUSIONS: Some anticonvulsants and antipsychotics seemed effective for acute bipolar depression, but most antipsychotics were not well tolerated. Antidepressants were effective and well-tolerated; lithium remains inadequately tested. LIMITATIONS: There are remarkably few short-term treatment trials (2.75/12 treatments), and fewer long-term trials for bipolar depression, possibly arising from exaggerated concerns about inducing mania. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/26042634/Efficacy_and_tolerability_of_treatments_for_bipolar_depression_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(15)00316-X DB - PRIME DP - Unbound Medicine ER -