Efficacy and safety of long-term antidepressant treatment for bipolar disorders – A meta-analysis of randomized controlled trials

Liu, Bangshan; Zhang, Yan; Han, Fang; Liu, Jin; Liu, Tiebang; Li, Lingjiang

doi:10.1016/j.jad.2017.07.023

Cited by 56 publications

(45 citation statements)

References 35 publications

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“…Early diagnosis is difficult in clinical practice because the onset of BD is often characterized by a depressive episode which can be similar in presentation to unipolar depression . Misdiagnosis of bipolar depression can result in inappropriate treatment with antidepressants without a concomitant mood stabilizer, which increases the risk of affective switching to hypomania or mania while not preventing new depressive episodes . Although depressive episodes in BD and unipolar depression share some established diagnostic features, a recent meta‐analysis identified family history of BD, early age of disease onset, and the presence of psychotic symptoms as the most consistent clinical predictors of conversion to BD in subjects with depression .…”

Section: Introductionmentioning

confidence: 99%

Serum uric acid as a predictor of bipolarity in individuals with a major depressive episode

et al. 2018

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| INTRODUC TI ONBipolar Disorder (BD) is one of the top 20 leading causes of disability worldwide. 1 It affects more than 1% of the population, with an estimated lifetime prevalence of 0.6% for type I BD, 0.4% for type II BD, and 1.4% for subthreshold manifestations of BD. 2 Despite the availability of effective treatments, the delay between the onset of BD and its diagnosis and management is often very long, with a pooled interval of almost 6 years. 3 Early diagnosis is difficult in clinical practice because the onset of BD is often characterized by a Objectives: There are no well-established biomarkers to predict the risk of conversion to bipolar disorder (BD) in patients with depression. Given the putative role of purinergic neurotransmission dysfunction in BD, the purpose of our study was to evaluate if higher serum uric acid (UA) levels could predict BD conversion in depressed inpatients. Methods:We reviewed retrospectively the records of subjects hospitalized between June 2007 and June 2010 with a diagnosis of major depressive disorder (MDD) who had undergone routine UA levels testing at admission. At an approximate 10-year follow-up we identified subjects with a subsequent diagnosis of BD. We compared UA levels between the BD-converter and non-BD converter groups, performed Receiver operating characteristic curve analysis to evaluate the prognostic accuracy of serum UA levels and calculated the clinical utility index (CUI) as a risk biomarker for conversion to BD. Results:The study included 250 subjects (55 "BD-converters" and 195 "No BD-converters"). "BD-converters" had significantly higher plasma UA levels compared to "No BD-converters" in their index hospitalization irrespective of gender (males:403.84 ± 91.76 vs 270.81 ± 53.58 µmol/L; U = 94.5, P < 0.001 and females 302.19 ± 52.64 vs 202.69 ± 48.93 µmol/L; t = 10.75, P < 0.001). Serum UA levels showed a very good to excellent accuracy for predicting conversion to BD in inpatients with MDD (area under the curve [AUC]: 0.90; 95% CI: 0.86, 0.94) and had a good to excellent CUI− and a moderate to good CUI+ grading for discriminating BDconverter cases from non-BD converters. Conclusions:Our study suggests that depressed patients with higher levels of serum UA are at greater risk of a subsequent manic or hypomanic episode. The purinergic system could prove a promising path for the search of biomarkers in BD. K E Y W O R D Sbipolar disorder, major depressive disorder, uric acid

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Section: Introductionmentioning

confidence: 99%

Serum uric acid as a predictor of bipolarity in individuals with a major depressive episode

et al. 2018

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“…57 A recent meta-analysis assessing the efficacy and safety of long-term antidepressant treatment for bipolar disorders reported a good efficacy of ADs in reducing depressive symptoms and a low risk of TEM when ADs were administered in combination with mood stabilizers (MSs). 58 The risk profiles for the development of an ADrelated TEM in BD differ significantly according to gender, with higher risk in females with a family history of BD-I and comorbid thyroid disorders, and in males with a history of suicide attempts and alcohol abuse. 59 So, even with the lack of published data, we can speculate that ADs should be used in comorbid BD/PMDD only during the acute depressive episodes of BD, in addiction to MS. Their use should be avoided during the manic states of BD and limited to refractory cases of PMDD during euthymic states.…”

Section: Antidepressants (Ads)mentioning

confidence: 99%

<p>Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges</p>

Sepede¹,

Brunetti²,

Giannantonio³

2020

NDT

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Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.

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“…Atypical neuroleptic drugs used to treat bipolar disorder can also have serious effects (eg, metabolic and neurologic effects, including irreversible tardive dyskinesia). 3,13,[40][41][42][43] Despite the good reasons to do so, many doctors (including some psychiatrists) do not ask their patients about a propensity to mania or hypomania. [4][5][6] More stigma is attached to the diagnosis of bipolar disorder than to depression [44][45][46][47] ; once it is in the medical record, the patient may have problems with employment and obtaining medical insurance.…”

Section: ■ Distinguishing Unipolar From Bipolar Depressionmentioning

confidence: 99%

Diagnosing and treating bipolar disorder in primary care

Koirala

Anand

2018

CCJM

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Efficacy and safety of long-term antidepressant treatment for bipolar disorders – A meta-analysis of randomized controlled trials

Cited by 56 publications

References 35 publications

Serum uric acid as a predictor of bipolarity in individuals with a major depressive episode

Serum uric acid as a predictor of bipolarity in individuals with a major depressive episode

<p>Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges</p>

Diagnosing and treating bipolar disorder in primary care

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