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Acta Psychiatr Scand. 2017 Jun;135(6):527-538. doi: 10.1111/acps.12712. Epub 2017 Mar 3.

Dopaminergic agents in the treatment of bipolar depression: a systematic review and meta-analysis.

Author information

1
Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Buenos Aires, Argentina.
2
Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.
3
Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
4
Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
5
National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
6
Global Health Systems Cluster, Harvard TH Chan School of Public Health, Boston, MA, USA.
7
International Consortium for Bipolar Disorder Research, Mc Lean Hospital, Belmont, MA, USA.
8
Center for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, Canada.
9
Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina.

Abstract

OBJECTIVE:

To systematically examine the effects of dopaminergic agents (modafinil, armodafinil, pramipexole, methylphenidate, and amphetamines) on bipolar depression outcomes.

METHODS:

Meta-analysis of randomized controlled trials was performed to assess the efficacy and safety of treatment with dopaminergic agents in bipolar depression. In a secondary analysis, findings from both randomized controlled trials and high-quality observational studies were pooled by means of meta-analytic procedures to explore dopaminergic treatment-related new mania.

RESULTS:

Nine studies (1716 patients) were included in our meta-analysis of randomized controlled trials. Treatment with dopaminergic agents for bipolar depression was associated with an increase in both response (1671 individuals, RR 1.25, 95% CI 1.05 to 1.50) and remission rates (1671 individuals, RR 1.40, 95% CI 1.14, 1.71). There was no evidence of an increased risk of mood switch associated with this treatment (1646 individuals, RR 0.96, 95% CI 0.49, 1.89). Our secondary analysis (1231 individuals) yielded a cumulative incidence of mood switch of 3% (95% CI 1.0, 5.0) during a mean follow-up period of 7.5 months.

CONCLUSIONS:

Preliminary findings suggest that dopaminergic agents may represent a useful alternative for the treatment of bipolar depression, with no evidence for a related increase in the risk of mood destabilization during short-term follow-up.

KEYWORDS:

bipolar depression; bipolar disorder; dopaminergic agents; manic switch; psychostimulants

PMID:
28256707
DOI:
10.1111/acps.12712
[Indexed for MEDLINE]

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