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Meta-Analysis
. 2022 Oct;146(4):290-311.
doi: 10.1111/acps.13471. Epub 2022 Jul 20.

A systematic review and meta-analysis of treatments for rapid cycling bipolar disorder

Rebecca Strawbridge  1 , Suman Kurana  1 , Jess Kerr-Gaffney  1 , Sameer Jauhar  1   2 , Kenneth R Kaufman  1   3 , Nefize Yalin  1 , Allan H Young  1   2
Affiliations
Meta-Analysis

A systematic review and meta-analysis of treatments for rapid cycling bipolar disorder

Rebecca Strawbridge et al. Acta Psychiatr Scand. 2022 Oct.

Abstract

Objectives: Rapid cycling is a common and disabling phenomenon in individuals with bipolar disorders. In the absence of a recent literature examination, this systematic review and meta-analysis aimed to synthesise the evidence of efficacy, acceptability and tolerability of treatments for individuals with rapid cycling bipolar disorder (RCBD).

Method: A systematic search was conducted to identify randomised controlled trials assigning participants with RCBD to pharmacological and/or non-pharmacological interventions. Study inclusion and data extraction were undertaken by two reviewers independently. The primary outcome was continuous within-subject RCBD illness severity before and after treatment. Pre-post random effects meta-analyses were conducted for each outcome/intervention arm studied, generating a standardised effect size (hedge's g) and 95% confidence interval (CI).

Results: A total of 34 articles describing 30 studies were included. A total of 16 separate pharmacological treatments were examined in contrast to 1 psychological therapy study. Only quetiapine and lamotrigine were assessed in >5 studies. By assessing 95% CI overlap of within-subject efficacy effects compared to placebo, the only interventions suggesting significant depression benefits (placebo g = 0.60) were olanzapine (with/without fluoxetine; g = 1.01), citalopram (g = 1.10) and venlafaxine (g = 2.48). For mania, benefits were indicated for quetiapine (g = 1.01), olanzapine (g = 1.19) and aripiprazole (g = 1.09), versus placebo (g = 0.33). Most of these effect sizes were from only one trial per treatment. Heterogeneity between studies was variable, and 20% were rated to have a high risk of bias.

Conclusions: While many interventions appeared efficacious, there was a lack of robust evidence for most treatments. Given the limited and heterogeneous evidence base, the optimal treatment strategies for people with RCBD are yet to be established.

Keywords: bipolar disorders; meta-analysis; rapid cycling; systematic review; treatment.

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Conflict of interest statement

In the last 3 years: Rebecca Strawbridge declares an honorarium from Lundbeck; Allan H. Young declares honoraria for speaking from Astra Zeneca, Lundbeck, Eli Lilly, Sunovion, honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, Janssen, and research grant support from Janssen; Sameer Jauhar has received honoraria for educational talks given for Lundbeck, Sunovian and Janssen, on antipsychotics; Nefize Yalin has worked on studies conducted together with Janssen Cliag, Corcept Therapeutics and COMPASS Pathways. No other conflicts of interest are declared.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of the study selection process.
FIGURE 2
FIGURE 2
Meta‐analysis effects of treatment classes. Forest plot displaying meta‐analysis comparisons (class level) pooled from >1 arms. Pre‐post effect size (Hedges' g) and 95% confidence intervals are shown. Blue colour represents treatment effects on global impression; green on depression; red on mania; grey colour displays control arms within each outcome category.
See this image and copyright information in PMC

References

    1. Vieta E, Langosch JM, Figueira ML, et al. Clinical management and burden of bipolar disorder: results from a multinational longitudinal study (WAVE‐bd). Int J Neuropsychopharmacol. 2013;16(8):1719‐1732. doi: 10.1017/S1461145713000278 - DOI - PubMed
    1. Diagnostic and Statistical Manual of Mental Disorders: DSM‐5. 5th ed. American Psychiatric Association; 2013. doi‐org.db29.linccweb.org/10.1176/appi.
    1. Dunner DL, Fieve RR. Clinical factors in lithium carbonate prophylaxis failure. Arch Gen Psychiatry. 1974;30(2):229‐233. doi: 10.1001/archpsyc.1974.01760080077013 - DOI - PubMed
    1. Kupka RW, Luckenbaugh DA, Post RM, et al. Comparison of rapid‐cycling and non‐rapid‐cycling bipolar disorder based on prospective mood ratings in 539 outpatients. Am J Psychiatry. 2005;162(7):1273‐1280. doi: 10.1176/appi.ajp.162.7.1273 - DOI - PubMed
    1. Carvalho AF, Dimellis D, Gonda X, Vieta E, McIntyre RS, Fountoulakis KN. Rapid cycling in bipolar disorder: a systematic review. J Clin Psychiatry. 2014;75(6):16864. doi: 10.4088/JCP.13r08905 - DOI - PubMed

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