First controlled treatment trial of bipolar II hypomania with mixed symptoms: Quetiapine versus placebo

Suppes, Trisha; Ketter, Terence A.; Gwizdowski, Iola S.; Dennehy, Ellen B.; Hill, Shelley J.; Fischer, E. Grace; Snow, Diane; Gonzalez, Robert; Sureddi, Suresh; Shivakumar, Geetha; Cosgrove, Victoria E.

doi:10.1016/j.jad.2013.02.031

Cited by 26 publications

(25 citation statements)

References 41 publications

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“…[13][14][15][16][17] Three studies assessed the efficacy of treatment of manic/hypomanic episodes with mixed features with 2 post-hoc analyses assessing olanzapine and asenapine for mania with mixed features and 1 RCT assessing adjunctive quetiapine for hypomania with mixed features. [18][19][20] Treatment of mania with mixed features…”

Section: Search Resultsmentioning

confidence: 99%

“…18,19 One small RCT suggested that adjunctive quetiapine for hypomania with mixed features improved symptoms of depression; however, it did not have a significant improvement in symptoms of hypomania compared to the placebo group. 20 For bipolar depression with mixed features, post-hoc analyses suggested antidepressant efficacy of olanzapine, OFC, and lurasidone compared to placebo. 13,16,17 One RCT showed antidepressant efficacy for ziprasidone in the acute treatment of a MDE with mixed features in subjects with BD-II or MDD, with a greater antidepressant effect in subjects with BD-II.…”

Section: Resultsmentioning

confidence: 99%

“…20 Participants included 55 BD-II subjects with a stable medication regimen for ≥2 weeks and hypomania with mixed symptoms (>12 on the YMRS and >15 on the MADRS at 2 consecutive visits 1-3 days apart). Participants were randomly assigned to receive adjunctive quetiapine (n = 30) or placebo (n = 25).…”

Section: Treatment Of Hypomania With Mixed Featuresmentioning

confidence: 99%

“…[9][10][11][12] Given the relative recency of this new nosological entity (May 2013), only a limited number of studies has directly examined the efficacy of treatments for mood states with DSM-5-defined mixed features. [13][14][15][16][17][18][19][20][21][22] Further, to date, only the Florida Medicaid Guidelines have specifically addressed the treatment of mixed features. 23 At the current time, inadequate evidence exists to adequately inform evidencebased treatment guidelines for mixed features in BD, as randomized controlled trials (RCTs) assessing the efficacy of various treatments specifically for BD mood episodes with mixed features have yet to be conducted.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of mixed features in bipolar disorder

Rosenblat

McIntyre

2016

CNS Spectr.

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Mood episodes with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-defined mixed features are highly prevalent in bipolar disorder (BD), affecting~40% of patients during the course of illness. Mixed states are associated with poorer clinical outcomes, greater treatment resistance, higher rates of comorbidity, more frequent mood episodes, and increased rates of suicide. The objectives of the current review are to identify, summarize, and synthesize studies assessing the efficacy of treatments specifically for BD I and II mood episodes (ie, including manic, hypomanic, and major depressive episodes) with DSM-5-defined mixed features. Two randomized controlled trials (RCTs) and 6 post-hoc analyses were identified, all of which assessed the efficacy of second-generation antipsychotics (SGAs) for the acute treatment of BD mood episodes with mixed features. Results from these studies provide preliminary support for SGAs as efficacious treatments for both mania with mixed features and bipolar depression with mixed features. However, there are inadequate data to definitively support or refute the clinical use of specific agents. Conventional mood stabilizing agents (eg, lithium and divalproex) have yet to have been adequately studied in DSM-5-defined mixed features. Further study is required to assess the efficacy, safety, and tolerability of treatments specifically for BD mood episodes with mixed features.

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Section: Search Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Treatment Of Hypomania With Mixed Featuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of mixed features in bipolar disorder

Rosenblat

McIntyre

2016

CNS Spectr.

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“…There are four placebo‐controlled trials that investigated divalproex (level 4),432 N ‐acetylcysteine (level 4),433 and quetiapine (level 4)434, 435; and one open‐label study of risperidone (level 4)436 in acute hypomania. The studies generally suggested efficacy but all had significant weaknesses, including one or more of: (i) small sample sizes, (ii) mixed samples with BDI, BDII, and BD NOS; (iii) mixed samples with hypomania and mania, and (iv) positive findings on some but not all outcomes.…”

Section: Bipolar II Disordermentioning

confidence: 99%

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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Guidelines on Mood Stabilizers

Gfesser

Kittel‐Schneider

2022

NeuroPsychopharmacotherapy

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First controlled treatment trial of bipolar II hypomania with mixed symptoms: Quetiapine versus placebo

Cited by 26 publications

References 41 publications

Treatment of mixed features in bipolar disorder

Treatment of mixed features in 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

Guidelines on Mood Stabilizers

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