Comparative efficacy and tolerability of pharmacological treatments for the treatment of acute bipolar depression: A systematic review and network meta-analysis

Objective: Addiction comorbidity is an important clinical challenge in mood disorders, but the best way of pharmacologically treating people with mood disorders and addictions remains unclear. The aim of this study was to assess the efficacy of pharmacological treatments for mood and addiction symptoms in people with mood disorders and addiction comorbidity. Methods: A systematic search of placebo-controlled randomized controlled trials investigating the effects of pharmacological treatments in people with bipolar disorder (BD) or major depressive disorder (MDD), and comorbid addictions was performed. Treatment-related effects on mood and addiction measures were assessed in a meta-analysis, which also estimated risks of participant dropout and adverse effects. Results: A total of 32 studies met systematic review inclusion criteria. Pharmacological therapy was more effective than placebo for improving manic symptoms (standardized mean difference [SMD] = −0.15; 95% confidence interval [95% CI], −0.29 to −0.02; P = 0.03) but not BD depressive symptoms (SMD = −0.09; 95% CI, −0.22 to 0.03; P = 0.15). Quetiapine significantly improved manic symptoms (SMD = −0.23; 95% CI, −0.39 to −0.06; P = 0.008) but not BD depressive symptoms (SMD = −0.07; 95% CI, −0.23 to 0.10; P = 0.42). Pharmacological therapy was more effective than placebo for improving depressive symptoms in MDD (SMD = −0.16; 95% CI, −0.30 to −0.03; P = 0.02). Imipramine improved MDD depressive symptoms (SMD = −0.58; 95% CI, −1.03 to −0.13; P = 0.01) but Selective serotonin reuptake Inhibitors (SSRI)-based treatments had no effect (SMD = −0.06; 95% CI, −0.30 to 0.17; P = 0.60). Pharmacological treatment improved the odds of alcohol abstinence in MDD but had no effects on opiate abstinence. Conclusions: Pharmacological treatments were significantly better than placebo in improving manic symptoms, MDD depressive symptoms, and alcohol abstinence but were not better for bipolar depression symptoms. Importantly, quetiapine was not more effective than placebo in improving bipolar depression symptoms nor were SSRI’s for the treatment of MDD depression. Our findings highlight the need for further high-quality clinical trials of treatments for mood disorders and comorbid addictions.

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Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: a systematic review and network meta-analysis

The Lancet Psychiatry ◽

10.1016/s2215-0366(14)70314-1 ◽

2014 ◽

Vol 1 (5) ◽

pp. 351-359 ◽

Cited By ~ 158

Author(s):

Tomofumi Miura ◽

Hisashi Noma ◽

Toshi A Furukawa ◽

Hiroshi Mitsuyasu ◽

Shiro Tanaka ◽

...

Keyword(s):

Systematic Review ◽

Bipolar Disorder ◽

Maintenance Treatment ◽

Meta Analysis ◽

Pharmacological Treatments ◽

Comparative Efficacy

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Comparative Efficacy of Pharmacological Treatments on Measures of Self -Rated Functional Outcomes Using the Sheehan Disability Scale in Patients with Major Depressive Disorder: A Systematic Review and Network Meta-analysis

CNS Spectrums ◽

10.1017/s1092852921000171 ◽

2021 ◽

pp. 1-28

Author(s):

Bing Cao ◽

Lu Xu ◽

Dongfang Wang ◽

Yena Lee ◽

Joshua D. Rosenblat ◽

...

Keyword(s):

Systematic Review ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Functional Outcomes ◽

Meta Analysis ◽

Sheehan Disability Scale ◽

Pharmacological Treatments ◽

Comparative Efficacy ◽

Major Depressive ◽

Disability Scale

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Comparative Efficacy and Acceptability of Non-pharmacological Interventions for Depression Among People Living With HIV: Protocol for a Systematic Review and Network-meta Analysis

10.21203/rs.3.rs-965146/v1 ◽

2021 ◽

Author(s):

Ting Zhao ◽

Chulei Tang ◽

Huang Yan ◽

Honghong Wang

Keyword(s):

Systematic Review ◽

Low Income ◽

Meta Analysis ◽

Global Network ◽

Controlled Trials ◽

Pharmacological Treatments ◽

Comparative Efficacy ◽

Pharmacological Interventions ◽

Middle Income ◽

Middle Income Countries

Abstract Background: Improving depression is critical to successful HIV treatment. Due to the adverse reactions of pharmacotherapy, treatment for depression in PLWH has increasingly turned to non-pharmacological treatments. However, the comparative efficacy and acceptability of non-pharmacological treatments for depression among PLWH in different resource contexts remain inconclusive. This protocol for a systematic review and network meta-analysis aims at evaluating the efficacy and acceptability of non-pharmacological treatments for depression among PLWH to guide future research and practice for all research settings and for low-income and middle-income countries (LMIC) only. Methods: We will include all randomized controlled trials of any non-pharmacological interventions to reduce depression in PLWH. The primary outcomes will be the efficacy (the overall mean change scores in depression) and acceptability (the proportion of participants who withdrew for any reason). We will systematically search Published studies through the related databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL) and the bibliographies. There is no restriction by language and publication year. At least two investigators will independently conduct all study selection, quality evaluation, and data extraction. We will employ a network meta-analysis to synthesize all available evidence for each outcome and obtain a comprehensive ranking of all interventions for the global network and for low-income and middle-income countries (LMICs) network only. We will employ validated local and global approaches to assess inconsistency. We will use OpenBUGS (version 3.2.3) to fit our model into the Bayesian framework. We will evaluate the strength of evidence with the GRADE system. Discussion: We will synthesize all available evidence and identify the most efficacious and acceptable non-pharmacological interventions for depression among PLWH for global network and for LMIC network only. The results of this study will be used to guide decision-making better in different resource settings.Systematic review registration: PROSPERO CRD42021244230.

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Comparative Efficacy and Tolerability of Adjunctive Pharmacotherapies for Acute Bipolar Depression: A Systematic Review and Network Meta-analysis: Efficacité Et Tolérabilité Comparatives Des Pharmacothérapies D’appoint Pour La Dépression Bipolaire Aiguë: Une Revue Systématique Et Une Méta-Analyse De Réseau

The Canadian Journal of Psychiatry ◽

10.1177/0706743720970857 ◽

2020 ◽

pp. 070674372097085

Author(s):

Anees Bahji ◽

Dylan Ermacora ◽

Callum Stephenson ◽

Emily R. Hawken ◽

Gustavo Vazquez

Keyword(s):

Systematic Review ◽

Bipolar Depression ◽

Data Extraction ◽

Meta Analysis ◽

Treatment Strategies ◽

Comparative Efficacy ◽

Eligibility Criteria ◽

Double Blind ◽

Augmentation Strategies ◽

Intravenous Ketamine

Objective: We investigated the comparative efficacy and tolerability of augmentation strategies for bipolar depression. Data Sources: We conducted a systematic review and network meta-analysis of 8 electronic databases for double-blind, randomized controlled trials of adjunctive pharmacotherapies for acute bipolar depression. Data Extraction and Synthesis: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and applied the Cochrane risk of bias tool for study quality appraisal. Two reviewers independently abstracted data. We resolved all discrepancies by consensus. Main Outcomes and Measures: Primary outcomes were response and completion of treatment. We estimated summary rate ratios (RRs) and standardized mean differences (SMDs) relative to placebo controls using frequentist random-effects network meta-analysis. Results: We identified 69 trials meeting eligibility criteria (8,007 participants, 42.8 years, 58.0% female). Adjunctive racemic intravenous ketamine, coenzyme Q10, pramipexole, fluoxetine, and lamotrigine were more effective than placebo. Summary RRs for response ranged between 1.51 (95% confidence interval [CI], 1.11 to 2.06) for fluoxetine and 12.49 (95% CI, 3.06 to 50.93) for racemic intravenous ketamine. For completion of treatment, risperidone appeared less tolerable than placebo (RR = 0.59; 95% CI, 0.38 to 0.94), while fluoxetine seemed more tolerable than placebo (RR = 1.13; 95% CI, 1.02 to 1.24). None of the investigated agents were associated with increased treatment-emergent mood switches. Conclusions and Relevance: The evidence for augmentation strategies in bipolar depression is limited to a handful of agents. Fluoxetine appeared to have the most consistent evidence base for both efficacy and tolerability. There remains a need for additional research exploring novel treatment strategies for bipolar depression, particularly head-to-head studies.

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