A network meta-analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania

Yıldız, Ayşegül; Nikodem, Mateusz; Vieta, Eduard; Correll, Christoph U.; Baldessarini, Ross J.

doi:10.1017/s0033291714001305

Cited by 118 publications

(107 citation statements)

References 69 publications

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“…In patients who are inadequately responsive to first‐line agents, second‐line choices include monotherapy with olanzapine (level 1), carbamazepine (level 1), ziprasidone (level 1), and haloperidol (level 1)143 or combination therapy with olanzapine plus lithium or divalproex (level 1). While each of these strategies has strong support for their efficacy, as indicated above, safety and tolerability concerns relegate them to second‐line options.…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

“…Agents recommended as third‐line options for treatment of acute mania include monotherapy with chlorpromazine (level 2),157 monotherapy with clonazepam (level 2),158 monotherapy or adjunctive therapy with clozapine (level 4),159, 160, 161, 162 and monotherapy with tamoxifen (level 2) 143. Tamoxifen is downgraded because of the risk of uterine cancer and the lack of clinical experience despite evidence for efficacy.…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

“…Antimanic efficacy has not been demonstrated for allopurinol (level 1 negative),167 eslicarbazepine/licarbazepine (level 2 negative),168 gabapentin (Level 2 negative), lamotrigine (level 1 negative),143 omega‐3 fatty acids (level 1 negative),169 topiramate (level 1 negative),143 valnoctamide (level 2 negative),170, 171 or zonisamide (level 2 negative)172 (Table 13). …”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…In addition, the reference lists of review articles relevant to this topic were manually searched to identify potentially eligible papers (Arbaizar et al, 2009;Biederman et al, 2005;Brown et al, 2013;Fountoulakis et al, 2009;Fountoulakis et al, 2011;McKeage, 2014;Meduri et al, 2016;Miura et al, 2014;Perlis, 2007;Perlis et al, 2006;Scherk et al, 2007;Smith et al, 2007;Taylor, 2003;Vieta et al, 2010;Yatham et al, 2013;Yildiz et al, 2015).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Pharmacological therapy is often the first-line treatment for BD, followed by psychological (Oud et al, 2016) and psychosocial interventions (Goodwin et al, 2008). In addition to lithium and anticonvulsants (van der Loos et al, 2011;Yildiz et al, 2015), antipsychotic agents have also shown promising efficacy for bipolar mania (Yildiz et al, 2011) and depression (Goodwin et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Efficacy, safety and tolerability of aripiprazole in bipolar disorder: An updated systematic review and meta-analysis of randomized controlled trials

Tseng²,

Stubbs

et al. 2017

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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-keung Chow , Efficacy, safety and tolerability of aripiprazole in bipolar disorder: An updated systematic review and meta-analysis of randomized controlled trials. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Pnp(2017Pnp( ), doi: 10.1016Pnp( /j.pnpbp.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.A C C E P T E D M A N U S C R I P T Aripiprazole was associated with lower relapse rates in bipolar mania when used in combination versus a placebo in maintenance therapy (odds ratio: 0.522, p<0.029). ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P TAripiprazole was also associated with higher levels of high density lipoprotein, lower dropout rates, but no difference in extrapyramidal symptoms in the maintenance phase versus a placebo or in comparison with other medications (haloperidol or lithium). Our results suggest that aripiprazole is effective and safe in treating bipolar mania. Further trials are necessary to evaluate the efficacy and tolerability versus other medications.

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A Positron Emission Tomography Study of Dopamine Transporter Density in Patients With Bipolar Disorder With Current Mania and Those With Recently Remitted Mania

et al. 2022

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ImportanceAlthough dopamine is implicated in the pathophysiology of bipolar disorder (BD), the precise alterations in the dopaminergic system remain unknown.ObjectiveTo assess dopamine transporter (DAT) density in the striatum in patients with BD with current and recently remitted mania in comparison to healthy control individuals and its correlation with severity of manic symptoms.Design, Setting, and ParticipantsThis cross-sectional study conducted in a tertiary care referral center for mood disorders in Vancouver, British Columbia, Canada, recruited 26 patients with BD (9 with current mania; 17 with recently remitted mania) and 21 matched healthy control individuals. DAT density was measured using positron emission tomography with [11C]d-threo-methylphenidate (MP). The differences between the groups in nondisplaceable binding potential (BPND) for DAT was assessed using statistical parametric mapping. The study was conducted from November 2001 to February 2007 and the data were analyzed from November 2020 to December 2021.Main Outcomes and MeasuresDAT density as indexed by BPND for MP across groups; manic symptom severity as measured with the Young Mania Rating Scale (YMRS) and correlated with BPND values in patients with BD.ResultsOf 47 total participants (mean [SD] age, 37.8 [14.4] years), 27 (57.4%) were female; 26 individuals had BD (9 with current mania and 17 with recently remitted mania) and there were 21 healthy control individuals. MP BPND was significantly lower in patients with BD in the right putamen and nucleus accumbens (mean reduction [MR] = 22%; cluster level familywise error [FWE]–corrected P &lt; .001) as well as left putamen and caudate (MR = 24%; cluster level FWE–corrected P &lt; .001). The reduction in BPND was more extensive and pronounced in patients with current mania, while patients with recently remitted mania had lower BPND in the left striatum but not the right. There was a significant negative correlation between YMRS scores and MP BPND in the right striatum in patients with current mania (ρ = −0.93; 95% CI, −0.99 to −0.69; P &lt; .001) and those with recently remitted mania (ρ = 0.64; 95% CI, −0.86 to −0.23; P = .005) but not in the left striatum in either group.Conclusions and RelevanceThese findings indicate that mania was associated with reduced DAT density and remitted mania was associated with DAT levels that approximated those present in individuals without BD. These results have potential implications for drug development for mania.

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A network meta-analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania

Abstract: Hierarchical rank ordering by comparative efficacy and risk of all-cause discontinuations should help to guide antimanic treatment choices by clinicians, healthcare policy makers, and guideline developers.

Cited by 118 publications

References 69 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Efficacy, safety and tolerability of aripiprazole in bipolar disorder: An updated systematic review and meta-analysis of randomized controlled trials

A Positron Emission Tomography Study of Dopamine Transporter Density in Patients With Bipolar Disorder With Current Mania and Those With Recently Remitted Mania

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