Acute bipolar mania: A systematic review and meta-analysis of co-therapy vs. monotherapy

South London and Maudsley NHS Foundation Trust, Londinium, England, United Kingdom
Acta Psychiatrica Scandinavica (Impact Factor: 5.55). 02/2007; 115(1):12-20. DOI: 10.1111/j.1600-0447.2006.00912.x
Source: PubMed

ABSTRACT The aim of this meta-analysis was to systematically review the effectiveness of co-therapy compared with monotherapy for people with bipolar mania.
MEDLINE, Embase, Psychinfo, The Cochrane Library and reference lists of retrieved studies were searched without language restrictions for randomized controlled trials evaluating co-therapy compared with monotherapy for acute bipolar mania. Each trial was assessed for susceptibility to bias. Data on mania outcomes, withdrawals, extrapyramidal symptoms and weight were extracted and pooled effect estimates summarized as relative risks (RR) or differences in mean values (MD) where appropriate.
Eight eligible studies were included (1124 participants). Significant reductions in mania (Young Mania Rating Scale, YMRS) scores were shown for haloperidol, olanzapine, risperidone and quetiapine as co-therapy compared with monotherapy with a mood stabilizer. For atypical antipsychotics combined, the pooled difference in mean scores was 4.41 (95% CI: 2.74, 6.07). Significantly more participants on co-therapy met the response criterion (at least 50% reduction in YMRS score), RR 1.53 (1.31, 1.80). With some drugs, co-therapy decreased tolerability compared with monotherapy, and resulted in greater weight gain. There were insufficient data to compare one co-therapy regimen with another.
The addition of antipsychotic treatment to established mood-stabilizer treatment is more effective than mood-stabilizer treatment alone.

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Available from: Victoria R Cornelius, Jan 02, 2014
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    • "Sometimes a triple combination (Lithium, an anticonvulsant and an atypical antipsychotic) may be needed in treatment resistant mania. Combinations of Olanzapine, Quetiapine, Risperidone and Aripiprazole with a mood stabiliser are more effective than therapy with a single mood stabiliser (Yatham 2005; Smith et al. 2007; Ketter 2008). Combinations are also useful in long term maintenance treatment. "
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    • "En effet, seulement 50 % des patients maniaques répondent à une monothérapie et 75 % à une bithérapie [32]. La littérature scientifique recommande les associations telles que le lithium ou le divalproate avec un antipsychotique atypique [37] [38]. Si un antipsychotique n'est pas déjà utilisé, les guidelines recommandent l'adjonction d'un antipsychotique quand la symptomatologie du patient comprend des signes psychotiques [39]. "
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    • "These rates of discontinuation are lower than those previously reported for atypical antipsychotics in 12-week studies of mania, which have ranged between 40 and 50% (Tohen et al., 2003; Smulevich et al., 2005; Vieta et al., 2005a,b). There was consistent evidence of lower rates of severe adverse events and adverse events leading to treatment discontinuation with valproate, as demonstrated in earlier studies (Smith et al., 2007). "
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