Preventing new episodes of bipolar disorder in adults: Systematic review and meta-analysis of randomized controlled trials

Nestsiarovich, Anastasiya; Gaudiot, Christopher; Baldessarini, Ross J.; Vieta, Eduard; Zhu, Yiliang; Tohen, Mauricio

doi:10.1016/j.euroneuro.2021.08.264

Cited by 47 publications

(34 citation statements)

References 48 publications

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“…This is in agreement with the study of Bond et al, which also suggested that divalproex is efficacious in the treatment of BD ( Dutta and Zhang, 2004 ). In addition, VPA can prevent new episodes of BD in adults, as reported by Nestsiarovich et al (2022) . Valproate (VPA) has been used to treat epilepsy and bipolar disorder for many years.…”

Section: Discussionmentioning

confidence: 84%

Efficacy, Safety, and Retention Rate of Extended-Release Divalproex Versus Conventional Delayed-Release Divalproex: A Meta-Analysis of Controlled Clinical Trials

Zhang¹,

Li²,

Wan³

et al. 2022

Front. Pharmacol.

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Purpose: A novel once-daily divalproex-extended release (ER) dose formulation has been developed; this formulation prolongs the therapeutic serum levels of the drug, compared with the twice-daily conventional divalproex-delayed release (DR) formulation. This study aimed to systematically examine and compare the efficacy, safety, and retention rates of the ER divalproex (VPA-ER) and conventional DR divalproex (VPA-DR) formulations.Methods: Randomized control trials (RCTs) reporting the efficacy, adverse events (AEs), and medication compliance of ER and DR divalproex were searched in online databases, including PubMed, Embase, and Cochrane Library databases, by searching MeSH words and term words. Observational studies with potential biases were excluded. The meta-analysis was performed using Stata 16.0 software.Findings: Thirteen RCTs, involving 1,028 participants, were included in this meta-analysis. Efficacy, AEs, and drug retention rates were the main study outcomes. According to our study, VPA-ER presented clinically significant benefits compared with the placebo in the population with bipolar disorder (BD) (39.5% versus 27.2%, p < 0.001). A similar efficacy of VPA-ER and VPA-DR in controlling seizures was observed in epilepsy patients (87.4% versus 86.5%, p = 0.769). A significantly lower incidence of AEs was reported in the VPA-ER group than in the placebo group (26.8% versus 34.8%, p = 0.003). By contrast, there was no evidence of difference in safety between VPA-ER and VPA-DR (29.4% versus 30.5%, p = 0.750). In addition, the drug retention rate was significantly lower in the VPA-ER group than in the placebo group (76.0% versus 82.7%, p = 0.020), especially in migraine patients (p = 0.022) and in patients who were treated for fewer than 4 weeks (p = 0.018).Implications: The efficacy of VPA-ER was significantly superior to that of the placebo treatment, which provided efficacy similar to that of conventional VPA-DR. VPA-ER is well tolerated with a low rate of AEs compared to the placebo. In addition, the acceptable medicine compliance of VPA-ER was conducive to the long-term maintenance treatment of chronic diseases. Although we analyzed open labels and crossover design RCTs, large-scale multicenter studies on the efficacy and medicine compliance of new ER formulations with less AEs are required to validate our conclusion.

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Section: Discussionmentioning

confidence: 84%

Efficacy, Safety, and Retention Rate of Extended-Release Divalproex Versus Conventional Delayed-Release Divalproex: A Meta-Analysis of Controlled Clinical Trials

Zhang¹,

Li²,

Wan³

et al. 2022

Front. Pharmacol.

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“…First- and second-generation antipsychotic drugs are used to treat patients with psychotic disorders, particularly schizophrenia ( 86 , 87 ), and patients with bipolar disorders ( 88 – 90 ). Furthermore, several second-generation antipsychotics are recommended as augmentation strategy in treatment-resistant depression ( 91 ).…”

Section: Resultsmentioning

confidence: 99%

“…Mood stabilizers are given in the context of bipolar disorders to prevent further depressive/manic episodes ( 88 – 90 ), and in MDD as augmentation ( 91 , 149 ) and, possibly prophylactic treatment (particularly lithium) ( 150 ). Lithium has been associated with sinus bradycardia, sinus node dysfunction, atrioventricular lock and ventricular irritability, and sick sinus syndrome is considered a cardiac contraindication for its use ( 151 , 152 ).…”

Section: Resultsmentioning

confidence: 99%

“…Psychotherapy, in particular cognitive behavioral therapy (CBT), is established in the treatment of most major mental disorders, and is also applied to treat patients with mental disorders in the context of an underlying physical disease as well as in cardiometabolic disorders themselves ( 90 , 159 – 163 ). In particular, adjustment disorder, anxiety and depressive disorders are frequent comorbidities in CVD, leading to decreased quality of life and in part worsen the disease course of the underlying physical illness ( 164 – 166 ).…”

Section: Resultsmentioning

confidence: 99%

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Psychological and Psychopharmacological Interventions in Psychocardiology

2022

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Patients with mental disorders have an increased risk to develop cardiovascular disease (CVD), and CVD are frequently comorbid with especially adjustment, anxiety and depressive disorders. Therefore, clinicians need to be aware of effective and safe psychological and pharmacological treatment strategies for patients with comorbid CVD and mental disorders. Cognitive behavioral therapy and third-wave of cognitive-behavioral therapy are effective for patients with CVD and mental disorders. Internet-based psychological treatments may also be considered. In more severe cases, psychopharmacological drugs are frequently used. Although generally well tolerated and efficacious, drug- and dose-dependent side effects require consideration. Among antidepressants, selective serotonin reuptake inhibitors, selective serotonin and noradrenalin reuptake inhibitors, and newer antidepressants, such as mirtazapine, bupropion, agomelatine, and vortioxetine, can be considered, while tricyclic antidepressants should be avoided due to their cardiac side effects. Mood stabilizers have been associated with arrhythmias, and some first- and second-generation antipsychotics can increase QTc and metabolic side effects, although substantial differences exist between drugs. Benzodiazepines are generally safe in patients with CVD when administered short-term, and may mitigate symptoms of acute coronary syndrome. Laboratory and ECG monitoring is always recommended in psychopharmacological drug-treated patients with CVD. Presence of a heart disease should not exclude patients from necessary interventions, but may require careful risk-benefit evaluations. Effectively and safely addressing mental disorders in patients with CVD helps to improve both conditions. Since CVD increase the risk for mental disorders and vice versa, care providers need to screen for these common comorbidities to comprehensively address the patients’ needs.

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“…5 Some examples here are the safety profile of first-generation antipsychotics, negative symptoms and tolerability issues with second-generation antipsychotics, the unsuitability of valproate medications for women with childbearing potential, and the need for monitoring to ensure non-toxicity with lithium. These are acknowledged by well-regarded, widely used clinical guidelines 6,7 and are supported by up-to-date systematic reviews and meta-analyses e.g., focused on acute treatment of mania, 8 depression, 9 maintenance treatment 10 and rapid cycling. 11 Each of the referenced syntheses here states a need for increased clinical trials, both of existing and new interventions.…”

Section: Introductionmentioning

confidence: 97%

Is acetazolamide a potential intervention for people with bipolar disorders? A scoping review protocol

Strawbridge

Orfanos

Yalın

et al. 2022

Preprint

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Acetazolamide is a carbonic anhydrase inhibitor whose primary indication is to alleviate altitude sickness, but it is also used in the treatment of glaucoma, seizures and oedema. Although it has not been repurposed for psychiatric illnesses, acetazolamide has been advocated for its putative benefits in those with a bipolar disorder (BD). Because current treatment options for BD bring a variety of challenges, it is important to examine the current evidence to date in a formal synthesis. This article describes a protocol for a scoping review to do so, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). PubMed, Embase and PsycInfo will be searched for all available publications focusing on the intervention acetazolamide for people with BD. This will include non-primary and primary research of any design, focusing on any outcome, in order to comprehensively bring together the work that has been undertaken to date on this topic. Relevant data from included articles will be subject to a narrative synthesis. It is anticipated that the results from the review will help to ascertain the potential for acetazolamide to benefit people with bipolar affective disorders in the future and aid the planning of future primary research to establish this.

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Preventing new episodes of bipolar disorder in adults: Systematic review and meta-analysis of randomized controlled trials

Cited by 47 publications

References 48 publications

Efficacy, Safety, and Retention Rate of Extended-Release Divalproex Versus Conventional Delayed-Release Divalproex: A Meta-Analysis of Controlled Clinical Trials

Efficacy, Safety, and Retention Rate of Extended-Release Divalproex Versus Conventional Delayed-Release Divalproex: A Meta-Analysis of Controlled Clinical Trials

Psychological and Psychopharmacological Interventions in Psychocardiology

Is acetazolamide a potential intervention for people with bipolar disorders? A scoping review protocol

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