Evidence of Treatment Options for Bipolar Disorder

Valproic Acid

The latest version of the evidence on valproic acid for bipolar disorder, which causes sudden changes in mood, has been published.

Study details

Twenty-five trials (3252 participants) compared valproic acid with either placebo or alternative anti-ic treatments to relieve symptoms of acute illness. Regarding efficacy, the main result was response rate.

For tolerability, our main result was the number of participants with adverse effects.

This meta-analysis included studies that focused on children, adolescents, and adults with a range of man symptom severity. The majority of studies focused on adult males and females (18 years and older) were conducted in inpatient settings and were completed in the United States.

Conclusion.

There is evidence that valproate is an effective treatment for acute illness in adults when compared to placebo. In contrast, there is no evidence of a difference in efficacy between valproate and placebo in children and adolescents. Valproic acid may be less effective than olanzapine in adults and may be inferior to risperidone as monotherapy in pediatric mania. In general, there is uncertain evidence as to whether valproic acid causes more or fewer side effects than other major antimanic therapies. However, there is evidence that valproate causes less weight gain and sedation than olanzapine.

Jochim J, Rifkin-Zybutz RP, Geddes J, Cipriani A. Cochrane Database of Systematic Reviews 2019, No. 10. Number: CD004052. doi: 10.1002 / 14651858.CD004052.pub2. 

Lithium.

Current evidence suggests that lithium can be prescribed as a medication to control bipolar disorder and prevent suicide due to impulsivity.

In this article, I will introduce a paper that studies the evidence.

The study

The study included male and female participants of all ages (n = 4220) who met all of the criteria for a manic episode in relation to a diagnosis of bipolar disorder.

Lithium vs. placebo

With high confidence evidence, lithium was found to be an effective treatment for acute illness and more effective than placebo in eliciting a response. Lithium was more likely to induce tremor than placebo.

Lithium counter-psychotic or mood stabilizer

There was only very low uncertainty evidence on lithium compared to haloperidol.

Lithium was probably less likely to elicit a response than olanzapine.

Lithium was possibly less likely to induce a reaction than risperidone.

There was no evidence of a difference between lithium and valproate.

There was evidence of moderate certainty that lithium is more effective than topiramate in the treatment of acute illness.

Conclusion.

This systematic review shows that lithium is more effective than placebo in the treatment of acute illness, but increases the risk of somnolence and tremor. There is limited evidence to show that there is little or no difference between lithium and other mood stabilizers (valproic acid, carbamazepine) or antipsychotics (risperidone, quetiapine, haloperidol). Olanzapine may be an exception, as it is perhaps slightly more effective than lithium. There is uncertain evidence that risperidone may be more effective than lithium. Lithium is probably more effective than topiramate in treating acute illness. When compared to placebo, lithium was more likely to cause adverse events. However, when compared to other drugs, there are too few studies providing data on adverse effects to provide reliable evidence. It was designed to be more rigorous.

McKnight RF, de La Motte deBroönsde Vauvert SJ, Chesney E, Amit BH, Geddes J, Cipriani A. Cochrane Database of Systematic Reviews 2019, No. 6. Number: CD004048. doi: 10.1002 / 14651858.CD004048.pub4.

Omega-3 fatty acids

Omega-3 fatty acids may improve mental health

This is the result of a study that investigates this.

What are the results of the studies?

Five studies have been reviewed.

However, the quality of the methodology varied widely.

Only one study, which included 75 participants, provided data for analysis.

Depressive symptom levels (WMD -3.93, 95% CI -7.00 to -0.86)

General clinical impression score (WMD -0.75, 95% CI -1.33 to -0.17)

Mania (WMD -2.81, 95% CI -7.68 to 1.90)

No serious adverse effects were reported in the five studies.

Dropout patterns were highly variable across studies.

Conclusion.

The results of one study showed a favorable effect of omega-3 as adjunctive therapy for manic, but not depressive, symptoms in bipolar disorder. Due to the limited data available, these findings need to be considered carefully. There is an urgent need for well-designed and executed randomized controlled trials in this area.

Montgomery P, Richardson AJ. Omega-3 fatty acids for bipolar disorder. Cochrane Database of Systematic Reviews 2008, No. 2. Number: CD005169. doi: 10.1002 / 14651858.CD005169.pub2.