title: Efficacy and acceptability of mood stabilisers in the treatment of acute bipolar depression: systematic review.
abstract: BACKGROUND
  Although people with bipolar disorder spend more time in a depressed than manic state, little evidence is available to guide the treatment of acute bipolar depression.
  
  
  OBJECTIVE
  To compare the efficacy, acceptability and safety of mood stabiliser monotherapy with combination and antidepressant treatment in adults with acute bipolar depression.
  
  
  METHODS
  Systematic review and meta-analysis of randomised, double-blind controlled trials.
  
  
  RESULTS
  Eighteen studies with a total 4105 participants were analysed. Mood stabiliser monotherapy was associated with increased rates of response (relative risk (RR) = 1.30, 95% CI 1.16-1.44, number needed to treat (NNT) = 10, 95% CI 7-18) and remission (RR = 1.51, 95% CI 1.27-1.79, NNT = 8, 95% CI 5-14) relative to placebo. Combination therapy was not statistically superior to monotherapy. Weight gain, switching and suicide rates did not differ between groups. No differences were found between individual medications or drug classes for any outcome.
  
  
  CONCLUSIONS
  Mood stabilisers are moderately efficacious for acute bipolar depression. Extant studies are few and limited by high rates of discontinuation and short duration. Further study of existing and novel agents is required.
authors.affiliation: Department of Psychiatry, Foothills Medical Centre, 1403-29th Street, NW, Calgary, AB, Canada.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Van Lieshout
authors.forename: Glenda M
authors.initials: GM
authors.lastname: MacQueen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents