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Title: Mood Stabilizers and Antipsychotics for Acute Mania: Systematic Review and Meta-Analysis of Augmentation Therapy vs Monotherapy From the Perspective of Time to the Onset of Treatment Effects
Authors: Tajika, Aran  kyouindb  KAKEN_id  orcid (unconfirmed)
Hori, Hikaru
Iga, Jun-ichi
Koshikawa, Yosuke
Ogata, Haruhiko
Ogawa, Yusuke  kyouindb  KAKEN_id  orcid (unconfirmed)
Watanabe, Koichiro
Kato, Tadafumi
Matsuo, Koji
Kato, Masaki
Author's alias: 田近, 亜蘭
小川, 雄右
Keywords: Antipsychotics
bipolar disorder
manic state
mood stabilizers
systematic review and meta-analysis
Issue Date: Oct-2022
Publisher: Oxford University Press (OUP)
Journal title: International Journal of Neuropsychopharmacology
Volume: 25
Issue: 10
Start page: 839
End page: 852
Abstract: Background: Existing meta-analytic evidence on bipolar mania treatment has revealed that augmentation therapy (AUG) with antipsychotics and mood stabilizers is more effective than monotherapy. However, the speed of the onset of treatment effects and subsequent changes in risk/benefit are unclear. Methods: We searched the Cochrane CENTRAL, MEDLINE, and EMBASE databases until January 2021. Our primary outcomes were response and tolerability. We set 3 time points: 1, 3, and 6 weeks after randomization. Results: Seventeen studies compared AUG therapy and MS monotherapy (comparison 1), and 8 studies compared AUG therapy and antipsychotics monotherapy (comparison 2). In comparison 1, AUG therapy resulted in significantly more responses than monotherapy, with an odds ratio of 1.45 (95% confidence interval [CI]: 1.17 to 1.80) at 3 weeks and 1.59 (95% CI: 1.28 to 1.99) at 6 weeks. Significant improvement was observed in the first week with a standardized mean difference of −0.25 (95% CI: −0.38 to −0.12). In comparison 2, AUG therapy was significantly more effective than monotherapy, with an odds ratio of 1.73 (95% CI: 1.25 to 2.40) at 3 weeks and 1.74 (95% CI: 1.11 to 2.73) at 6 weeks. Significant improvement was observed in the first week with an standardized mean difference of −0.23 (95% CI: −0.39 to −0.07). Regarding tolerability, there was no significant difference between AUG therapy and monotherapy at 3 and 6 weeks in both comparisons. Conclusions: Early AUG therapy should be considered, as it has shown efficacy from weeks 1 to 6, although attention to side effects is necessary for acute mania treatment.
Rights: © The Author(s) 2023. Published by Oxford University Press on behalf of CINP.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI(Published Version): 10.1093/ijnp/pyac050
PubMed ID: 35932466
Appears in Collections:Journal Articles

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