Relapse Prevention Studies

Background and Objectives: This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating and preventing new depressive or manic episodes. This paper will discuss the evidence of their efficacy relative to the polarity of relapse from controlled acute and maintenance/relapse prevention studies in bipolar patients. Materials and Methods: A Medline search was conducted for controlled acute and maintenance studies with carbamazepine, oxcarbazepine, and eslicarbazepine in bipolar disorder. In addition, abstracts reporting on controlled studies with these medications from key conferences were taken into consideration. Results: Information was extracted from 84 articles on the acute and prophylactic efficacy of the medications under consideration. They all appear to have stronger efficacy in treating acute mania than depression, which also translates to better protection against manic than depressive relapses for carbamazepine. Still, there is a paucity of controlled acute studies on bipolar depression for all and, with the exception of carbamazepine, a lack of long-term monotherapy maintenance data. For eslicarbazepine, the efficacy in bipolar disorder remains largely unknown. Especially with carbamazepine, tolerability issues and drug–drug interactions need to be kept in mind. Conclusions: Two of the medications discussed in this review, carbamazepine and oxcarbazepine, match Class A criteria according to the criteria proposed by Ketter and Calabrese, meaning acute antimanic efficacy, prevention of manic relapses, and not causing or worsening depression.

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Long-acting injectable paliperidone palmitate versus oral paliperidone extended release: a comparative analysis from two placebo-controlled relapse prevention studies

Annals of General Psychiatry ◽

10.1186/1744-859x-12-22 ◽

2013 ◽

Vol 12 (1) ◽

pp. 22 ◽

Cited By ~ 20

Author(s):

Michael Markowitz ◽

Dong-Jing Fu ◽

Bennett Levitan ◽

Srihari Gopal ◽

Ibrahim Turkoz ◽

...

Keyword(s):

Comparative Analysis ◽

Relapse Prevention ◽

Extended Release ◽

Paliperidone Palmitate ◽

Prevention Studies ◽

Long Acting ◽

Paliperidone Extended Release

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Placebo response in schizophrenia

European Psychiatry ◽

10.1017/s0924933800001061 ◽

1994 ◽

Vol 9 (3) ◽

pp. 119-120 ◽

Cited By ~ 5

Author(s):

Τ Lewander

Keyword(s):

Active Treatment ◽

Relapse Prevention ◽

Response Rate ◽

Placebo Response ◽

New Drugs ◽

Structured Interviews ◽

Short Term ◽

Prevention Studies ◽

Symptom Rating

SummaryA review of the literature on placebo-controlled studies in schizophrenia reveals, that the percentage of placebo responders in short-term trials amounts to 0–40%; on active treatment the response rate is 40–60%. In relapse prevention studies 18–100% of patients on placebo relapsed as compared to 0–40% on active treatment. Factors of importance for the variability between studies are discussed. Desirable designs of explanatory and pivotal studies, the importance of placebo controlled relapse prevention studies, and more rigorous assessment methods, eg video-taped and structured interviews for diagnostic and symptom rating purposes, are proposed as a means to improve the quality of the clinical documentation of new drugs.

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Strengths of families to limit relapse in mentally ill family members

Health SA Gesondheid ◽

10.4102/hsag.v22i0.1019 ◽

2017 ◽

Vol 22 ◽

Author(s):

Tlhalefi T. Tlhowe ◽

Emmerentia Du Plessis ◽

Magdalene P. Koen

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Mentally Ill ◽

Relapse Prevention ◽

Family Members ◽

Daily Activities ◽

Family Strengths ◽

Prevention Studies ◽

Phenomenological Design

Background: Relapse prevention in mental health care is important. Utilising the strengths of families can be a valuable approach in relapse prevention. Studies on family strengths have been conducted but little has been done on the strengths of family members to help limit relapse in mental health care users. The purpose of this research was to explore and describe the strengths of family members in assisting mental health care users to limit relapses.Methods: A phenomenological design was followed. Purposive sampling was used and 15 family members of mental health care users who have not relapsed in the previous two years participated. Individual unstructured interviews were conducted. Data were analyse dusing thematic analysis.Results: Four main themes were identified, namely accepting the condition of the mental health care users, having faith, involving the mentally ill family members in daily activities and being aware of what aggravates the mentally ill family members.Conclusions: Family members go through a process of acceptance and receive educational information and assistance from health professionals. In this process families discover and apply their strengths to limit relapses of mentally ill family members. It is important that family members caring for mentally ill family members are involved in their treatment from the onset, and that they are guided through a process of acceptance.

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Agomelatine efficacy and acceptability revisited: systematic review and meta-analysis of published and unpublished randomised trials

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.120196 ◽

2013 ◽

Vol 203 (3) ◽

pp. 179-187 ◽

Cited By ~ 52

Author(s):

Markus Koesters ◽

Giuseppe Guaiana ◽

Andrea Cipriani ◽

Thomas Becker ◽

Corrado Barbui

Keyword(s):

Major Depression ◽

Relapse Prevention ◽

Rating Scale ◽

Meta Analysis ◽

Antidepressant Drug ◽

Prevention Studies ◽

Randomised Controlled ◽

Meta Analyses ◽

Unipolar Major Depression

BackgroundAgomelatine is a novel antidepressant drug with narrative, non-systematic reviews making claims of efficacy.AimsThe present study systematically reviewed published and unpublished evidence of the acute and long-term efficacy and acceptability of agomelatine compared with placebo in the treatment of major depression.MethodRandomised controlled trials comparing agomelatine with placebo in the treatment of unipolar major depression were systematically reviewed. Primary outcomes were (a) Hamilton Rating Scale for Depression (HRSD) score at the end of treatment (short-term studies) and (b) number of relapses (long-term studies).ResultsMeta-analyses included 10 acute-phase and 3 relapse prevention studies. Seven of the included studies were unpublished. Acute treatment with agomelatine was associated with a statistically significant superiority over placebo of −1.51 HRSD points (99% Cl −2.29 to −0.73, nine studies). Data extracted from three relapse prevention studies failed to show significant effects of agomelatine over placebo (relative risk 0.78, 99% Cl 0.41−1.48). Secondary efficacy analyses showed a significant advantage of agomelatine over placebo in terms of response (with no effect for remission). None of the negative trials were published and conflicting results between published and unpublished studies were observed.ConclusionsWe found evidence suggesting that a clinically important difference between agomelatine and placebo in patients with unipolar major depression is unlikely. There was evidence of substantial publication bias.

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