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Cited by 122Bipolar Disorder and TreatmentTreatment of Major DepressionSchizophrenia research and treatment

Comparative Efficacy and Acceptability of Drug Treatments for Bipolar Depression: A Multiple-Treatments Meta-Analysis

Taylor, D. M., Cornelius, V., Smith, L., Young, A. H.·2014·Acta Psychiatrica Scandinavica
DOI 10.1111/acps.12343
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Abstract

Objective Treatment of bipolar depression is complicated by variable response and risk of switch to mania. Guidance is informed by the strength of evidence rather than by comparative data. Method We performed a multiple-treatments meta-analysis of randomised, double-blind, controlled comparisons of 4-16 weeks in adults in bipolar depression. The primary efficacy outcome was effect size. The primary acceptability outcome was 'switch to mania'. Secondary outcomes were likelihood of response and withdrawals from trials. Results Twenty-nine studies were included (8331 participants). Olanzapine + fluoxetine and olanzapine performed best on primary outcome measure being ranked highest for effect size. Switch to mania was least likely with ziprasidone and then quetiapine. Olanzapine + fluoxetine was also ranked the highest for response with lurasidone second, but olanzapine + fluoxetine and olanzapine had the optimal effect on response and withdrawal from treatment when the two parameters were considered together. Several treatments [monoamine oxidase inhibitors (MAOIs), ziprasidone, aripiprazole and risperidone] have limited or no therapeutic activity in bipolar depression. Conclusion Olanzapine + fluoxetine should be first-line treatment. Olanzapine, quetiapine, lurasidone, valproate and selective serotonin re-uptake inhibitors are also recommended. Tricyclic antidepressants and lithium are worthy of consideration but lamotrigine (high risk of switching, less robust efficacy) and…

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Crossref · 10.1111/acps.12343

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  • Second-generation antipsychotic medication is the mainstay of treatment of psychotic disorders and is increasingly prescribed for other indications.

    “Second generation antipsychotic medication is the mainstay of treatment of psychotic disorders (1) and is increasingly prescribed for other indications like bipolar disorder and severe depression and off-label indications such as sleeplessness and anxiety (2, 3).”

    From Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [2]

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Authors
Taylor, D. M., Cornelius, V., Smith, L., & Young, A. H.
Affiliations
  • King's College London (GB)
  • Oxford Brookes University (GB)
Corresponding author
Taylor, D. M.
ORCID
Venue
Acta Psychiatrica Scandinavica
Publisher
Wiley
Published
2014-10-06
Volume
130
Issue
6
Pages
452-469
ISSN
0001-690X (ISSN-L)
DOI
10.1111/acps.12343
OpenAlex
W2132517122
Cited by
122
References
10
Citations by year
2026: 3 · 2025: 7 · 2024: 4 · 2023: 2 · 2022: 13 · 2021: 12 · 2020: 15 · 2019: 11 · 2018: 9 · 2017: 18 · 2016: 16 · 2015: 10 · 2014: 2
FWCI
10.93
Type
journal article
Language
en
Open access
closed
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 330 d)
Locations
  • Acta Psychiatrica Scandinavica (publishedVersion)
  • PubMed (publishedVersion)
  • Repository@Hull (Worktribe) (University of Hull) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
bipolar depression, bipolar disorder, olanzapine, fluoxetine, treatment response, treatment withdrawal, antidepressant efficacy, quetiapine, lurasidone, ziprasidone, aripiprazole, risperidone, valproic acid, selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, lamotrigine, monoamine oxidase inhibitors, first-line therapy
MeSH terms
Aripiprazole, Lurasidone Hydrochloride, Quetiapine Fumarate, Olanzapine, Lamotrigine, Adult, Antidepressive Agents, Benzodiazepines, Bipolar Disorder, Depression, Dibenzothiazepines, Drug Therapy, Combination, Fluoxetine, Humans, Monoamine Oxidase Inhibitors, Piperazines, Thiazoles, Antipsychotic Agents, Triazines, Valproic Acid, Quinolones, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Lithium Compounds, Risperidone, Isoindoles

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