Tomofumi Miura1, Hisashi Noma2, Toshi A Furukawa3, Hiroshi Mitsuyasu4, Shiro Tanaka5, Sarah Stockton6, Georgia Salanti7, Keisuke Motomura4, Satomi Shimano-Katsuki4, Stefan Leucht8, Andrea Cipriani9, John R Geddes6, Shigenobu Kanba4. 1. Department of Neuropsychiatry Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: tmiura@npsych.med.kyushu-u.ac.jp. 2. Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan. 3. Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan. 4. Department of Neuropsychiatry Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 5. Department of Pharmacoepidemiology, Kyoto University School of Public Health, Kyoto, Japan. 6. Department of Psychiatry, University of Oxford, Oxford, UK. 7. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. 8. Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany. 9. Department of Psychiatry, University of Oxford, Oxford, UK; Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
Abstract
BACKGROUND: Lithium is the established standard in the long-term treatment of bipolar disorder, but several new drugs have been assessed for this indication. We did a network meta-analysis to investigate the comparative efficacy and tolerability of available pharmacological treatment strategies for bipolar disorder. METHODS: We systematically searched Embase, Medline, PreMedline, PsycINFO, and the Cochrane Central Register of Controlled Trials for randomised controlled trials published before June 28, 2013, that compared active treatments for bipolar disorder (or placebo), either as monotherapy or as add-on treatment, for at least 12 weeks. The primary outcomes were the number of participants with recurrence of any mood episode, and the number of participants who discontinued the trial because of adverse events. We assessed efficacy and tolerability of bipolar treatments using a random-effects network meta-analysis within a Bayesian framework. FINDINGS: We screened 114 potentially eligible studies and identified 33 randomised controlled trials, published between 1970 and 2012, that examined 17 treatments for bipolar disorder (or placebo) in 6846 participants. Participants assigned to all assessed treatments had a significantly lower risk of any mood relapse or recurrence compared with placebo, except for those assigned to aripiprazole (risk ratio [RR] 0·62, 95% credible interval [CrI] 0·38-1·03), carbamazepine (RR 0·68, 0·44-1·06), imipramine (RR 0·95, 0·66-1·36), and paliperidone (RR 0·84, 0·56-1·24). Lamotrigine and placebo were significantly better tolerated than carbamazepine (lamotrigine, RR 5·24, 1·07-26·32; placebo, RR 3·60, 1·04-12·94), lithium (RR 3·76, 1·13-12·66; RR 2·58, 1·33-5·39), or lithium plus valproate (RR 5·95, 1·02-33·33; RR 4·09, 1·01-16·96). INTERPRETATION: Although most of the drugs analysed were more efficacious than placebo and generally well tolerated, differences in the quality of evidence and the side-effect profiles should be taken into consideration by clinicians and patients. In view of the efficacy in prevention of both manic episode and depressive episode relapse or recurrence and the better quality of the supporting evidence, lithium should remain the first-line treatment when prescribing a relapse-prevention drug in patients with bipolar disorder, notwithstanding its tolerability profile. FUNDING: None.
BACKGROUND:Lithium is the established standard in the long-term treatment of bipolar disorder, but several new drugs have been assessed for this indication. We did a network meta-analysis to investigate the comparative efficacy and tolerability of available pharmacological treatment strategies for bipolar disorder. METHODS: We systematically searched Embase, Medline, PreMedline, PsycINFO, and the Cochrane Central Register of Controlled Trials for randomised controlled trials published before June 28, 2013, that compared active treatments for bipolar disorder (or placebo), either as monotherapy or as add-on treatment, for at least 12 weeks. The primary outcomes were the number of participants with recurrence of any mood episode, and the number of participants who discontinued the trial because of adverse events. We assessed efficacy and tolerability of bipolar treatments using a random-effects network meta-analysis within a Bayesian framework. FINDINGS: We screened 114 potentially eligible studies and identified 33 randomised controlled trials, published between 1970 and 2012, that examined 17 treatments for bipolar disorder (or placebo) in 6846 participants. Participants assigned to all assessed treatments had a significantly lower risk of any mood relapse or recurrence compared with placebo, except for those assigned to aripiprazole (risk ratio [RR] 0·62, 95% credible interval [CrI] 0·38-1·03), carbamazepine (RR 0·68, 0·44-1·06), imipramine (RR 0·95, 0·66-1·36), and paliperidone (RR 0·84, 0·56-1·24). Lamotrigine and placebo were significantly better tolerated than carbamazepine (lamotrigine, RR 5·24, 1·07-26·32; placebo, RR 3·60, 1·04-12·94), lithium (RR 3·76, 1·13-12·66; RR 2·58, 1·33-5·39), or lithium plus valproate (RR 5·95, 1·02-33·33; RR 4·09, 1·01-16·96). INTERPRETATION: Although most of the drugs analysed were more efficacious than placebo and generally well tolerated, differences in the quality of evidence and the side-effect profiles should be taken into consideration by clinicians and patients. In view of the efficacy in prevention of both manic episode and depressive episode relapse or recurrence and the better quality of the supporting evidence, lithium should remain the first-line treatment when prescribing a relapse-prevention drug in patients with bipolar disorder, notwithstanding its tolerability profile. FUNDING: None.
Authors: Cathy Davies; Andrea Cipriani; John P A Ioannidis; Joaquim Radua; Daniel Stahl; Umberto Provenzani; Philip McGuire; Paolo Fusar-Poli Journal: World Psychiatry Date: 2018-06 Impact factor: 49.548
Authors: Danella M Hafeman; Brian Rooks; John Merranko; Fangzi Liao; Mary Kay Gill; Tina R Goldstein; Rasim Diler; Neal Ryan; Benjamin I Goldstein; David A Axelson; Michael Strober; Martin Keller; Jeffrey Hunt; Heather Hower; Lauren M Weinstock; Shirley Yen; Boris Birmaher Journal: J Am Acad Child Adolesc Psychiatry Date: 2019-07-29 Impact factor: 8.829
Authors: Azmeraw T Amare; Klaus Oliver Schubert; Liping Hou; Scott R Clark; Sergi Papiol; Urs Heilbronner; Franziska Degenhardt; Fasil Tekola-Ayele; Yi-Hsiang Hsu; Tatyana Shekhtman; Mazda Adli; Nirmala Akula; Kazufumi Akiyama; Raffaella Ardau; Bárbara Arias; Jean-Michel Aubry; Lena Backlund; Abesh Kumar Bhattacharjee; Frank Bellivier; Antonio Benabarre; Susanne Bengesser; Joanna M Biernacka; Armin Birner; Clara Brichant-Petitjean; Pablo Cervantes; Hsi-Chung Chen; Caterina Chillotti; Sven Cichon; Cristiana Cruceanu; Piotr M Czerski; Nina Dalkner; Alexandre Dayer; Maria Del Zompo; J Raymond DePaulo; Bruno Étain; Peter Falkai; Andreas J Forstner; Louise Frisen; Mark A Frye; Janice M Fullerton; Sébastien Gard; Julie S Garnham; Fernando S Goes; Maria Grigoroiu-Serbanescu; Paul Grof; Ryota Hashimoto; Joanna Hauser; Stefan Herms; Per Hoffmann; Andrea Hofmann; Stephane Jamain; Esther Jiménez; Jean-Pierre Kahn; Layla Kassem; Po-Hsiu Kuo; Tadafumi Kato; John Kelsoe; Sarah Kittel-Schneider; Sebastian Kliwicki; Barbara König; Ichiro Kusumi; Gonzalo Laje; Mikael Landén; Catharina Lavebratt; Marion Leboyer; Susan G Leckband; Alfonso Tortorella; Mirko Manchia; Lina Martinsson; Michael J McCarthy; Susan McElroy; Francesc Colom; Marina Mitjans; Francis M Mondimore; Palmiero Monteleone; Caroline M Nievergelt; Markus M Nöthen; Tomas Novák; Claire O'Donovan; Norio Ozaki; Urban Ösby; Andrea Pfennig; James B Potash; Andreas Reif; Eva Reininghaus; Guy A Rouleau; Janusz K Rybakowski; Martin Schalling; Peter R Schofield; Barbara W Schweizer; Giovanni Severino; Paul D Shilling; Katzutaka Shimoda; Christian Simhandl; Claire M Slaney; Alessio Squassina; Thomas Stamm; Pavla Stopkova; Mario Maj; Gustavo Turecki; Eduard Vieta; Julia Volkert; Stephanie Witt; Adam Wright; Peter P Zandi; Philip B Mitchell; Michael Bauer; Martin Alda; Marcella Rietschel; Francis J McMahon; Thomas G Schulze; Bernhard T Baune Journal: JAMA Psychiatry Date: 2018-01-01 Impact factor: 21.596
Authors: Lakshmi N Yatham; Sidney H Kennedy; Sagar V Parikh; Ayal Schaffer; David J Bond; Benicio N Frey; Verinder Sharma; Benjamin I Goldstein; Soham Rej; Serge Beaulieu; Martin Alda; Glenda MacQueen; Roumen V Milev; Arun Ravindran; Claire O'Donovan; Diane McIntosh; Raymond W Lam; Gustavo Vazquez; Flavio Kapczinski; Roger S McIntyre; Jan Kozicky; Shigenobu Kanba; Beny Lafer; Trisha Suppes; Joseph R Calabrese; Eduard Vieta; Gin Malhi; Robert M Post; Michael Berk Journal: Bipolar Disord Date: 2018-03-14 Impact factor: 6.744
Authors: Susie A Hales; Martina Di Simplicio; Lalitha Iyadurai; Simon E Blackwell; Kerry Young; Christopher G Fairburn; John R Geddes; Guy M Goodwin; Emily A Holmes Journal: Behav Cogn Psychother Date: 2018-07-09