title: Dopaminergic agents in the treatment of bipolar depression: a systematic review and meta-analysis.
abstract: To systematically examine the effects of dopaminergic agents (modafinil, armodafinil, pramipexole, methylphenidate, and amphetamines) on bipolar depression outcomes.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Buenos Aires, Argentina.|Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.|Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
authors.forename: A G
authors.identifier: 0000-0002-9048-1367
authors.initials: AG
authors.lastname: Szmulewicz
authors.affiliation: Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.|Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: F
authors.initials: F
authors.lastname: Angriman
authors.affiliation: Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
authors.forename: C
authors.initials: C
authors.lastname: Samamé
authors.affiliation: Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Ferraris
authors.affiliation: Global Health Systems Cluster, Harvard TH Chan School of Public Health, Boston, MA, USA.|International Consortium for Bipolar Disorder Research, Mc Lean Hospital, Belmont, MA, USA.|Center for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Vigo
authors.affiliation: Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.|Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina.
authors.forename: S A
authors.initials: SA
authors.lastname: Strejilevich
mesh_terms: D001714:Bipolar Disorder / Q000188:drug therapy*; D015259:Dopamine Agents / Q000627:therapeutic use*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D015259:Dopamine Agents
keywords: bipolar depression; bipolar disorder; dopaminergic agents; manic switch; psychostimulants