Andre Delgado1, Jorge Velosa1, Junyu Zhang2, Serdar M Dursun3, Flavio Kapczinski4, Taiane de Azevedo Cardoso5. 1. McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada; Hospital Beatriz Angelo, Department of Psychiatry and Mental Health, Loures, Portugal. 2. McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada; Laboratory of Fear and Anxiety Disorders, Institute of Life Science, Nanchang University, Nanchang, China. 3. University of Alberta, Department of Psychiatry, Alberta, Canada. 4. McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada. 5. McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada. Electronic address: deazevet@mcmaster.ca.
Abstract
OBJECTIVES: To assess the clinical efficacy of clozapine in bipolar disorder and its adverse effect profile. METHODS: A literature search with no year and no language restriction was conducted. The search yielded 3858 articles, with 2453 remaining after duplicate removal; 9 were suitable for the systematic review. From the 9 included studies, 3 (100 patients treated with clozapine and 102 patients treated with other antipsychotics) could be included in a meta-analysis to test clozapine efficacy in the treatment of manic episodes. RESULTS: Clozapine's efficacy was similar to other antipsychotics (Mean difference (MD): 0.03 [95%CI: 0.86-0.92], p = 0.59) in manic episodes. The systematic review also suggested that clozapine is faster at improving symptoms in manic episodes. In addition, two studies included patients with treatment resistant bipolar disorder (TRBD) and showed that clozapine is superior to other treatments for this specific population. Sedation was the most frequent side effect (49.6%), followed by constipation (31.8%) and tachycardia (23.2%). CONCLUSION: Clozapine's efficacy was similar to other antipsychotics in manic episodes and is superior to other antipsychotics among TRBD patients.
OBJECTIVES: To assess the clinical efficacy of clozapine in bipolar disorder and its adverse effect profile. METHODS: A literature search with no year and no language restriction was conducted. The search yielded 3858 articles, with 2453 remaining after duplicate removal; 9 were suitable for the systematic review. From the 9 included studies, 3 (100 patients treated with clozapine and 102 patients treated with other antipsychotics) could be included in a meta-analysis to test clozapine efficacy in the treatment of manic episodes. RESULTS:Clozapine's efficacy was similar to other antipsychotics (Mean difference (MD): 0.03 [95%CI: 0.86-0.92], p = 0.59) in manic episodes. The systematic review also suggested that clozapine is faster at improving symptoms in manic episodes. In addition, two studies included patients with treatment resistant bipolar disorder (TRBD) and showed that clozapine is superior to other treatments for this specific population. Sedation was the most frequent side effect (49.6%), followed by constipation (31.8%) and tachycardia (23.2%). CONCLUSION:Clozapine's efficacy was similar to other antipsychotics in manic episodes and is superior to other antipsychotics among TRBD patients.