Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials

2016 ◽  
Vol 3 (12) ◽  
pp. 1138-1146 ◽  
Author(s):  
Alexander McGirr ◽  
Paul A Vöhringer ◽  
S Nassir Ghaemi ◽  
Raymond W Lam ◽  
Lakshmi N Yatham
Keyword(s):  
Systematic Review ◽  
Atypical Antipsychotic ◽  
Second Generation ◽  
Bipolar Depression ◽  
Meta Analysis ◽  
Antidepressant Therapy ◽  
Controlled Trials ◽  
Mood Stabiliser ◽  
Safety And Efficacy

scholarly journals Efficacy and acceptability of mood stabilisers in the treatment of acute bipolar depression: systematic review

2010 ◽  
Vol 196 (4) ◽  
pp. 266-273 ◽  
Author(s):  
Ryan J. Van Lieshout ◽  
Glenda M. MacQueen
Keyword(s):  
Systematic Review ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Number Needed To Treat ◽  
Mood Stabiliser ◽  
Double Blind ◽  
Manic State ◽  
Gain Switching ◽  
Drug Classes

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.

scholarly journals Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 701-715 ◽  
Author(s):  
Daniel Yavin ◽  
Steven Casha ◽  
Samuel Wiebe ◽  
Thomas E Feasby ◽  
Callie Clark ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Spinal Stenosis ◽  
Lumbar Fusion ◽  
Meta Analysis ◽  
Current Evidence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Safety And Efficacy ◽  
Relative Safety

Abstract BACKGROUND: Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. OBJECTIVE: To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications. METHODS: A systematic review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS: The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality. CONCLUSION: Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).

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