Comparative efficacy and tolerability of pharmacological interventions for acute bipolar depression in adults: a systematic review and network meta-analysis
In review (101 RCTs, n=20,081) olanzapine+fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine more effectively reduced depressive symptoms vs placebo. Standardised mean differences ranged from 0.41 (95% CI 0.19–0.64) to 0.16 (0.03–0.29).
Source:
The Lancet Psychiatry
SPS commentary:
An editorial suggests that a major challenge in effectively treating bipolar depression is the complexity and diversity of its aetiology and presentation. Currently only five pharmacological treatments (cariprazine, lumateperone, lurasidone, olanzapine–fluoxetine combination, and quetiapine) are approved by the FDA for acute bipolar depression. By contrast, there are over 30 medications in US approved for the treatment of major depressive disorder. It highlights that although this is not the first review of treatments for bipolar depression, it is the largest to date, and the first to assess the reliability of evidence using the GRADE approach. It notes the review emphasises the urgent need for further investigation of current and novel pharmacotherapies, but does not assess non-pharmacological interventions, psychosocial treatments (e.g. cognitive behaviour therapy, dialectical behaviour therapy, or psychoeducation) and neurostimulation treatments – these require consideration and assessment through well designed RCTs.