title: Second generation antipsychotics in the treatment of bipolar depression: a systematic review and meta-analysis.
abstract: Depressive symptoms and episodes dominate the course of bipolar disorder. However, the therapeutic armamentarium for bipolar depression is limited. Recent evidence points to the efficacy of second generation antipsychotics (SGAs) for the treatment of bipolar depression. We conducted a systematic review and meta-analysis of the efficacy and safety of SGAs (randomized, double-blind, placebo-controlled trials; used in monotherapy) in the treatment of adult patients with bipolar depression. Publication bias was corrected for by performing similar searches using the clinical trials register of the respective pharmaceutical companies, the Cochrane Database and ClinicalTrials.gov. Seven published papers were identified on the use of aripiprazole, olanzapine and quetiapine. Internal validity of the trials was fairly good, external validity only moderate. Different outcome measures of efficacy and safety were assessed. When the individual trials were looked at, quetiapine and to a lesser extent olanzapine demonstrated significant improvement in MADRS (Montgomery-Åsberg Depression Rating Scale) total scores. This was not demonstrated for aripiprazole. Efficacy was hampered by adverse events, such as weight gain, akathisia and somnolence/sedation. Both clinical heterogeneity of the included trials and statistical heterogeneity of the meta-analytic data were considerable. The number of quetiapine trials was disproportionate to the number of trials of aripiprazole and olanzapine. Further research is needed to assess differential efficacy of the different SGAs and their use in clinical practice.
authors.affiliation: Department of Psychiatry, General Hospital Sint-Jan Brugge-Oostende AV, Brugge, Belgium. jurgendefruyt@skynet.be
authors.forename: Jürgen
authors.initials: J
authors.lastname: De Fruyt
authors.forename: Ellen
authors.initials: E
authors.lastname: Deschepper
authors.forename: Kurt
authors.initials: K
authors.lastname: Audenaert
authors.forename: Eric
authors.initials: E
authors.lastname: Constant
authors.forename: Michel
authors.initials: M
authors.lastname: Floris
authors.forename: William
authors.initials: W
authors.lastname: Pitchot
authors.forename: Pascal
authors.initials: P
authors.lastname: Sienaert
authors.forename: Daniel
authors.initials: D
authors.lastname: Souery
authors.forename: Stephan
authors.initials: S
authors.lastname: Claes
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D014150:Antipsychotic Agents