Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: A meta-analysis

Nuria Cruz, Jose Sanchez-Moreno, Ferran Torres, Jose Manuel Goikolea, Marc Valent, Eduard Vieta

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    Abstract

    Randomized, controlled trials have demonstrated efficacy for second-generation antipsychotics in the treatment of acute mania in bipolar disorder. Despite depression being considered the hallmark of bipolar disorder, there are no published systematic reviews or meta-analyses to evaluate the efficacy of modern atypical antipsychotics in bipolar depression. We systematically reviewed published or registered randomized, double-blind, placebo-controlled trials (RCTs) of modern antipsychotics in adult bipolar I and/or II depressive patients (DSM-IV criteria). Efficacy outcomes were assessed based on changes in the Montgomery-Asberg Depression Rating Scale (MADRS) during an 8-wk period. Data were combined through meta-analysis using risk ratio as an effect size with a 95% confidence interval (95% CI) and with a level of statistical significance of 5% (p<0.05). We identified five RCTs; four involved antipsychotic monotherapy and one addressed both monotherapy and combination with an antidepressant. The two quetiapine trials analysed the safety and efficacy of two doses: 300 and 600 mg/d. The only olanzapine trial assessed olanzapine monotherapy within a range of 5-20 mg/d and olanzapine-fluoxetine combination within a range of 5-20 mg/d and 6-12 mg/d, respectively. The two aripiprazole placebo-controlled trials assessed doses of 5-30 mg/d. Quetiapine and olanzapine trials (3/5, 60%) demonstrated superiority over placebo (p<0.001). Only 2/5 (40%) (both aripiprazole trials) failed in the primary efficacy measure after the first 6 wk. Some modern antipsychotics (quetiapine and olanzapine) have demonstrated efficacy in bipolar depressive patients from week 1 onwards. Rapid onset of action seems to be a common feature of atypical antipsychotics in bipolar depression. Copyright © 2009 CINP.
    Original languageEnglish
    Pages (from-to)5-14
    JournalInternational Journal of Neuropsychopharmacology
    Volume13
    Issue number1
    DOIs
    Publication statusPublished - 1 Feb 2010

    Keywords

    • Antipsychotic drugs
    • Bipolar disorder
    • Depression
    • Placebo-controlled trials

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    Cruz, N., Sanchez-Moreno, J., Torres, F., Goikolea, J. M., Valent, M., & Vieta, E. (2010). Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: A meta-analysis. International Journal of Neuropsychopharmacology, 13(1), 5-14. https://doi.org/10.1017/S1461145709990344