BackgroundAlthough people with bipolar disorder spend more time in a depressed than
manic state, little evidence is available to guide the treatment of acute
bipolar depression.AimsTo compare the efficacy, acceptability and safety of mood stabiliser
monotherapy with combination and antidepressant treatment in adults with
acute bipolar depression.MethodSystematic review and meta-analysis of randomised, double-blind
controlled trials.ResultsEighteen studies with a total 4105 participants were analysed. Mood
stabiliser monotherapy was associated with increased rates of response
(relative risk (RR) = 1.30, 95% CI 1.16–1.44, number needed to treat
(NNT) = 10, 95% CI 7–18) and remission (RR = 1.51, 95% CI 1.27–1.79, NNT
= 8, 95% CI 5–14) relative to placebo. Combination therapy was not
statistically superior to monotherapy. Weight gain, switching and suicide
rates did not differ between groups. No differences were found between
individual medications or drug classes for any outcome.ConclusionsMood stabilisers are moderately efficacious for acute bipolar depression.
Extant studies are few and limited by high rates of discontinuation and
short duration. Further study of existing and novel agents is
required.
Antidepressant treatment in patients following acute coronary syndromes: a systematic review and Bayesian meta‐analysis
