Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis

Cipriani, Andrea; Barbui, Corrado; Salanti, Georgia; Rendell, Jennifer M; Brown, Rachel; Stockton, Sarah; Purgato, Marianna; Spineli, Loukia M.; Goodwin, Guy M.; Geddes, John

doi:10.1016/s0140-6736(11)60873-8

Cited by 562 publications

(437 citation statements)

References 26 publications

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“…The large majority met criteria for ADHD and oppositional defiant disorder, which, however, did not account for the extreme mood instability of these children. The superiority of an antipsychotic agent, such as risperidone, over non-antipsychotic mood stabilizers, such as lithium and valproate, in the TEAM study is consistent with the data in adults in acute mania [6]. It is also consistent with the well-documented efficacy of risperidone in alleviating symptoms of severe irritability in children with autism [7].…”

supporting

confidence: 82%

How Effective are the Current Treatments for Children Diagnosed with Manic/Mixed Bipolar Disorder?

Vitiello

2013

CNS Drugs

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supporting

confidence: 82%

How Effective are the Current Treatments for Children Diagnosed with Manic/Mixed Bipolar Disorder?

Vitiello

2013

CNS Drugs

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“…In addition, gabapentin has been found to be effective in prevention of frequent migraine headaches (Mathew et al, 2001) and other pain syndromes (Dallocchio et al, 2000;Rapchuk et al, 2010). Gabapentin has been studied in bipolar disorder with less than optimal results (Cipriani et al, 2011). Gabapentin is a lipophilic compound that was initially synthesized to mimic the chemical structure of GABA by addition of a cyclohexyl to its backbone (Honarmand et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Gabapentin Administration on Brain GABA and Glutamate Concentrations: A 7T 1H-MRS Study

Cai

Nanga

Lamprou

et al. 2012

Neuropsychopharmacol

129

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Gamma-aminobutyric acid (GABA) and glutamate are implicated in numerous neuropsychiatric and substance abuse conditions, but their spectral overlap with other resonances makes them a challenge to quantify in humans. Gabapentin, marketed for the treatment of seizures and neuropathic pain, has been shown to increase in vivo GABA concentration in the brain of both rodents and humans. Gabapentin effects on glutamate are not known. We conducted a gabapentin (900 mg) challenge in healthy human subjects to confirm and explore its effects on GABA and glutamate concentrations, respectively, and to test the ability of single voxel localized proton magnetic resonance spectroscopy ( 1 H-MRS) to reliably measure GABA and glutamate in the visual cortex at the ultra-high magnetic field of 7 Tesla. Reproducibility of GABA and glutamate measurements was determined in a comparison group without drug twice within day and 2 weeks apart. Although GABA concentration changes were small both within day (average 5.6%) and between day (average 4.8%), gabapentin administration was associated with an average increase in GABA concentration of 55.7% (6.9-91.0%). Importantly, druginduced change in GABA levels was inversely correlated to the individual's baseline GABA level (R 2 ¼ 0.72). Mean glutamate concentrations did not change significantly with or without drug administration. In conclusion, localized 1 H-MRS at 7 Tesla can be successfully applied to the measurement of GABA concentration and is sensitive to acute drug-induced changes in cortical GABA. Whether baseline GABA concentrations predict clinical efficacy of gabapentin is an area worthy of exploration.

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“…39,42 The transdiagnostic benefits of a drug like quetiapine, which is antipsychotic, antimanic, and antidepressant in both unipolar and bipolar depression, emphasises the importance of the investigation of treatment effects across conventional diagnostic boundaries. 9,40,43 However, this nonspecificity and scarcity of convincing evidence of long-term disease modification by known mechanisms suggests that the effects are mediated by short-term alleviation of symptoms. Nonetheless, because bipolar depression is very difficult to treat, this relief is often useful for patients and clinicians.…”

Section: Treatment Of Bipolar Depressionmentioning

confidence: 99%

“…Neurotransmitter and neurohormonal dysregulation Dopamine 9,10 Antipsychotic agents block dopamine D2 receptors and are potent antimanics Serotonin 11 Selective serotonin reuptake inhibitors of uncertain efficacy, atypical antipsychotics enhance serotonin activity…”

Section: Evidence Of Target Validationmentioning

confidence: 99%

The Treatment of Bipolar Disorder

Möller¹,

Nasrallah²

2017

Oxford Medicine Online

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We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation.

show abstract

Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis

Cited by 562 publications

References 26 publications

How Effective are the Current Treatments for Children Diagnosed with Manic/Mixed Bipolar Disorder?

How Effective are the Current Treatments for Children Diagnosed with Manic/Mixed Bipolar Disorder?

The Impact of Gabapentin Administration on Brain GABA and Glutamate Concentrations: A 7T 1H-MRS Study

The Treatment of Bipolar Disorder

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