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Comparing Antiepileptics for Bipolar Disorder, Migraines, Fibromyalgia, and Chronic Pain

How do antiepileptics compare in treating bipolar disorder?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: October 1, 2010

Antipsychotic Medicines for Treating Schizophrenia and Bipolar Disorder: A Review of the Research for Adults and Caregivers

This summary talks about one type of medicine—antipsychotics— used to treat schizophrenia and bipolar disorder. It will tell you what research says about how older and newer antipsychotics compare for treating schizophrenia and bipolar disorder in adults. Please note that the research on antipsychotics as treatment for bipolar disorder is limited, and more research is needed. This summary will also tell you about the possible side effects of antipsychotics. It can help you talk with your doctor about whether or not one of these antipsychotic medicines might be right for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: April 10, 2013

Risperidone in the long‐term treatment for bipolar disorder

No studies involving risperidone were identified which randomly assigned treatment for long‐term relapse prevention. Trials involving random assignment of risperidone and other treatments for long‐term treatment are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Tiagabine to treat acute affective episodes in bipolar disorder

This systematic review investigated the evidence base for the efficacy and acceptability of tiagabine compared to placebo and other pharmacological agents in the acute treatment of bipolar disorder. No randomised controlled trials were found. Currently, there is insufficient evidence on which to base any recommendations regarding the use of tiagabine in acute treatment of bipolar illness, either as a single treatment or as an additional treatment. A significant proportion of patients suffered episodes of syncope or seizure. There is a need for randomised controlled trials examining the efficacy and acceptability of tiagabine in the acute treatment of bipolar disorder, after the nature of these episodes has been clarified.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Oxcarbazepine in the maintenance treatment of bipolar disorder

Some studies have suggested that oxcarbazepine, an anti‐convulsant, may have a role in preventing episode recurrence in bipolar affective disorder. This systematic review investigated the efficacy and acceptability of oxcarbazepine compared to placebo and other agents in the maintenance treatment of bipolar disorder. Two randomised controlled trials were found that met the methodological inclusion criteria. However, in both cases, data were reported with insufficient clarity to be confidently extracted for inclusion in a meta‐analysis. Currently, there is insufficient evidence on which to base any recommendations on the use of oxcarbazepine in the maintenance treatment of bipolar illness, either in monotherapy or as an adjunctive treatment. There is need for good quality randomised controlled trials examining the efficacy and acceptability of oxcarbazepine in the maintenance treatment of bipolar disorder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Tiagabine in the maintenance treatment of bipolar disorder

People with bipolar disorder suffer from repeated episodes of severe mood disturbance. These can vary from mania to severe depression.  Sometimes manic and depressive symptoms can occur at the same time. Episodes may also fluctuate frequently, so‐called 'rapid cycling'. Periods of normal mood and function may occur in between these episodes, but this is not always the case.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Family interventions for bipolar disorder

Drug treatments are the primary treatment for bipolar disorder. Alone, however, they are not sufficient to manage the disorder. Studies on psychosocial interventions for mental disorders such as schizophrenia and anxiety show that they are effective treatments. Reports in the literature suggest that they may be useful for people with bipolar disorder as well. The role of the family is important in the care of people with bipolar disorder, with effective family functioning helping to maintain a person's psychological balance. This systematic review investigated the effectiveness of any psychosocial family intervention for people with bipolar disorder and/or their families and carers. Seven randomised controlled trials (393 participants) were included in the review, all of which evaluated psychoeducational interventions. Five studies compared family interventions against no treatment, and three studies compared one type or delivery of family intervention against another family intervention. Differences in the interventions, outcome measures and end points used in the trials did not allow us to perform a meta‐analysis. Whilst results from individual studies did not suggest a significant effect for family interventions when added to drug therapy, the studies provide insufficient evidence to draw conclusions which can be generalised to everyday practice. Further research using appropriate randomised controlled trial methodology and evaluating family interventions other than psychoeducation is called for in this under‐researched and important topic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Valproate for acutre mood episodes in bipolar disorder

This systematic review investigated the efficacy and acceptability of valproate compared to that of placebo, lithium, carbamazepine, olanzapine and haloperidol in the treatment of acute episodes of bipolar disorder. Ten randomised studies were included in the review: all examined patients with mania. Valproate was more effective than placebo in the treatment of mania. There was no significant difference between efficacy in valproate and lithium or between valproate and carbamazepine, but there were fewer data on these comparisons and so these questions remain unanswered. The evidence suggests that valproate may be less effective in reducing manic symptoms than olanzapine but may cause less sedation and weight gain. There remains a need for more trials comparing medicines in treating all affective episodes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Omega‐3 fatty acids for bipolar disorder

This systematic review investigated the efficacy of omega‐3 fatty acids for bipolar disorder. Five randomised controlled trials met inclusion criteria for the review. Only one trial provided data that could be analysed, investigating ethyl‐EPA as an adjunctive treatment in a mixed outpatient population. Some positive benefits were found for depressive symptoms but not for mania, and no adverse events were reported. There is currently insufficient evidence on which to base any clear recommendations concerning omega‐3 fatty acids for bipolar disorder. However, given the general health benefits and safety of omega‐3, the preliminary evidence from this review provides a strong case for well‐powered, high‐quality trials in specific index populations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Interventions for helping people recognise early signs of recurrence in bipolar disorder

Bipolar disorder (BPD), or manic‐depressive psychosis, is a common and severe mental illness, with a lifetime prevalence of 1‐2%. BPD is characterised by two types of recurrence, mania and depression. High rates of recurrence and associated adverse consequences occur in spite of a range of effective treatments. Early warning signs (EWS) interventions, targeted at improving the recognition and self‐management of manic and depressive symptoms, are intended to train people with recurrent bipolar affective disorder to recognise early warning signs of recurrence and to avert adverse outcomes. This review demonstrated that these interventions, in addition to treatment as usual (TAU), including medication and regular appointments with health professionals, have benefits on time to recurrence and hospitalisation. Compared with TAU only, EWS interventions also resulted in improved functioning at eighteen months, although these data were sparse and the findings should be interpreted with caution. EWS interventions did not appear to have any effect on depressive or manic symptoms, although again, these findings were based on small numbers of potentially selected patients in remission. It should be noted that EWS was used along with other psychological interventions, and it is not entirely clear what proportion of the beneficial effect was due to the EWS intervention alone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Topiramate for acute affective episodes in bipolar disorder

This systematic review investigated the efficacy and acceptability of topiramate compared to placebo and other agents in the treatment of acute affective episodes in bipolar disorder. One randomised controlled trial met the inclusion criteria for the review, a comparison between topiramate and bupropion sustained release (SR) in the adjunctive treatment of depressed patients with bipolar disorder. However, the published data, particularly the data on efficacy, required clarification before it could be analysed according to the protocol of this systematic review. Several unpublished trials have been identified and data from these trials may be included in future reviews. Currently, there is insufficient evidence on which to base any recommendations regarding the use of topiramate in any phase of bipolar illness, either in monotherapy or as an adjunctive treatment. There is a need for randomised controlled trials examining the efficacy and acceptability of topiramate in the treatment of all acute affective episodes in bipolar disorder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Olanzapine in long‐term treatment for bipolar disorder

Bipolar affective disorder is a severe and common mental illness, characterised by periods of mania, depression and "mixed episodes" (or "dysphoric mania": a mixture of manic and depressed symptoms). Antipsychotic drugs are often used to treat acute manic episodes and one commonly used antipsychotic drug that has recently been approved for use in mania in USA and Europe is olanzapine. This review considered the efficacy, acceptability and adverse effects of olanzapine in long‐term treatment of bipolar disorder in comparison with placebo or other active drug comparisons. Five trials (1165 participants) met the inclusion criteria and are included in the review. Based on a limited amount of information, olanzapine may prevent further mood episodes (especially manic relapse) in patients who responded to olanzapine during an index manic or mixed episode and who have not previously had a satisfactory response to lithium or valproate. The olanzapine group had significantly fewer patients suffering from insomnia than the placebo group, but a significantly larger number of people suffering from weight gain. When compared with lithium, olanzapine caused more weight gain and depressive symptoms but fewer insomnia and nausea symptoms and a lower rate of manic worsening. However, considering the lack of clear findings of this review, conclusions on efficacy and acceptability of olanzapine compared to placebo, lithium or valproate cannot be made with any degree of confidence

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Oxcarbazepine for acute affective episodes of bipolar disorder

People with bipolar disorder suffer from repeated episodes of severe mood disturbance. These can vary from mania to severe depression.  Sometimes manic and depressive symptoms can occur at the same time. Episodes may also fluctuate frequently, so‐called 'rapid‐cycling'. Periods of normal mood and function may occur in between these episodes, but this is not always the case.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Valproate for keeping people with bipolar disorder well, after mood episodes

We searched, in a wide‐ranging way, for all the useful studies (randomised controlled trials, or RCTs) we could find on long‐term treatment of people with bipolar disorder using valproate or any other mood stabiliser, or antipsychotic drugs, or placebo. Three of us looked at RCTs to make sure they were fair experiments. We extracted data from the studies, put all of the evidence together and carried out a statistical analysis to look for significant results.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Aripiprazole alone or in combination with other drugs for treating the acute mania phase of bipolar disorder

Bipolar disorder is a mental disorder that is seen as periods of high mood called mania, or hypomania if less severe, and periods of low mood (depression).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Types of depression

There are different types and severities of depression. Some only arise under certain circumstances, for example after giving birth.The most common form of depression is known as unipolar depression. People experience several typical symptoms such as feeling low, exhaustion, joylessness and a lack of motivation for at least two weeks. Depending on how many symptoms a person has and how severe they are, depression is classed as mild, moderate or severe.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 5, 2012

Comparing Atypical Antipsychotics

How do atypical antipsychotics compare in schizophrenia?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: February 11, 2011

Lithium versus antidepressants in the long‐term treatment of unipolar affective disorder

This systematic review investigated the efficacy and tolerability of lithium compared to antidepressants for the long‐term treatment of unipolar affective disorder. Eight randomised studies (reporting on 475 participants) were included in the review. We found no reliable evidence of any robust differences between lithium and antidepressants but nor could we reliably exclude the possibility of clinically significant differences. In this review some studies included a mixed group of participants with either bipolar or unipolar disorder. The review suggests that, while lithium may be of benefit in preventing relapse in unipolar affective disorder, there remains uncertainty about the treatment effect in comparison with antidepressants. Interpretation of this review should consider that the number of participants in the studies was small and the included studies had methodological shortcomings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Azapirones versus placebo for panic disorder in adults

Panic disorder is common in the general population and is often associated with various psychiatric disorders. Azapirones are a class of drugs occasionally used in the treatment of panic disorder, although none has been approved by a regulatory agency for this purpose. They are associated with less drowsiness, psychomotor impairment, alcohol potentiation and potential for addiction or abuse. However, azapirones are not widely used for panic disorder. Evidence for their efficacy in treating panic disorder is unclear. It is important to find out if azapirones are effective and acceptable in the treatment of panic disorder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Signs of depression

It is not always easy to diagnose depression. Several typical symptoms lasting for more than two weeks may be a sign that someone is depressed. In children and teenagers, however, depression often has different symptoms.We all experience deep sadness and anxiety every now and again, especially when faced with a particularly challenging or painful situation in life. That can sometimes lead to depression. Depression is more than simply feeling blue or having a bad day. Typical symptoms are long periods of feeling low, lack of motivation and lack of interest. People no longer enjoy things they used to enjoy, find it difficult to work or study, and neglect their friends and family.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 12, 2013

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