Antidepressants in Acute Bipolar Depression: An Inconclusive Meta-Analysis

Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain. .
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 03/2011; 72(3):415-6; author reply 416. DOI: 10.4088/JCP.10lr06638
Source: PubMed
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    ABSTRACT: A detailed review was published in 2004 on the therapeutic properties of the medications used in the treatment of bipolar disorders (Tamayo, JM et al. Actas Esp Psiquiatr 2004;32(Supl. 1):3-17). At the time it could be concluded that although mood stabilizers (euthymics) share some action mechanisms, they are also significantly different from each other with respect to their therapeutic properties in the various phases of bipolar disorders. This led to a proposed change in their generic classification as “mood stabilizers” to a new classification that includes: antimanic medications, partial mood stabilizers, and euthymics. Since then, several randomized, double-blind studies and meta-analyses that explore the effectiveness and tolerability of these medications have been published. This updated review aims to assess the validity of the proposed classification in the light of new evidence.
    Actas espanolas de psiquiatria 09/2011; 39(5):312-30. · 1.20 Impact Factor

  • The Journal of Clinical Psychiatry 10/2011; 72(10):1429-31. DOI:10.4088/JCP.11ac07357 · 5.50 Impact Factor
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    ABSTRACT: Background: The treatment of patients with bipolar disorder (BD) is complex and psychiatrists often have to change treatment strategies. However, available data do not provide information about the most frequent patterns of treatment strategies prescribed in clinical practice and clinical/socio-demographic factors of drugs prescription. Objective: The aims of this study were: (1) to identify specific patterns of life-time treatment strategies in a representative sample of bipolar patients; (2) to assess consistency with guidelines recommendations; and (3) to investigate clinical/socio-demographic of patients. Methods: Six-hundred and four BD I and II out-patients were enrolled in a naturalistic cohort study at the Barcelona Bipolar Disorders Program, in a cross-sectional analysis. A principal component analysis was applied to group psychotropic drugs into fewer underlying clusters which represent patterns of treatment strategies more frequently adopted in the life-time naturalistic treatment of BD. Results: Three main factors corresponding to three main prescription patterns were identified, which explained about 60% of cases, namely, Factor 1 (21.1% of common variance), defined the "antimanic stabilisation package" including treatments with antimanic mechanism of action in predominantly manic-psychotic BD I patients; Factor 2 (20.4%), "antidepressive stabilisation package" that grouped predominantly depressed patients, and Factor 3 (16.4%) defined the "anti-bipolar II package", including antidepressant monotherapy in BD II patients with depressive predominant polarity, melancholic features and higher rates of suicide behaviours. Conclusions: This study identified three patterns of lifetime treatment strategies in three specific and different groups of naturalistically treated bipolar patients.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 08/2012; 23(4). DOI:10.1016/j.euroneuro.2012.07.015 · 4.37 Impact Factor
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