Acute Bipolar Depression: Which Medications to Consider?
This most recent systematic review and network meta-analysis published in Lancet Psychiatry in Sep 2023 is considered the largest network meta-analysis of pharmacotherapy for bipolar depression to date.
WHAT DID THEY DO?
- Analysed data from 101 randomized controlled trials
- Total participants: 20 081
- 8063 men (41·7%) and 11 263 women (58·3%; sex not available in four studies)
- Mean age 41·0 years (range of means 28·7-53·6 years)
WHAT DID THEY FOUND?
- With moderate confidence in the evidence, olanzapine plus fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine were more efficacious than placebo in reducing depressive symptoms
- with SMDs ranging from 0·41 (95% CI 0·19-0·64) for olanzapine plus fluoxetine to 0·16 (0·03-0·29) for lamotrigine.
- Several other drugs might also be efficacious, but the confidence in the evidence was very low to low.
- Antidepressants as a class seem to be efficacious, but had a higher risk for manic switch compared to antipsychotics.
- Medications differed in their side-effect profiles.
FOR ACADEMY MEMBERS:
BIPOLAR DEPRESSION: 6 CLINICAL QUESTIONS
Watch the following 6 clinically relevant discussions by Dr. Lakshmi Yatham
on the topic of Bipolar Depression:
(1) Is Watchful Waiting Appropriate for Bipolar Depression?
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(2) Antidepressants in Bipolar Depression: When to Use & When to Avoid?
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(3) How Long to Continue Adjunct Antidepressants in Bipolar Depression?
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(4) Is Lamotrigine >200 mg Effective for Bipolar Depression?
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(5) Is Quetiapine 600 mg More Efficacious than 300 mg for Bipolar Depression?
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(6) Which Subgroup of Bipolar Disorder Patients Respond Well to Lithium?
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