All the Meds for Bipolar Depression [60 Sec Psych]

A new meta-analysis ranked all the medications for bipolar depression, and we found a surprise in the stack. A review of Bahji A, Ermacora D, Stephenson C, Hawken ER, Vazquez G. Comparative efficacy and tolerability of pharmacological treatments for the treatment of acute bipolar depression: A systematic review and network meta-analysis. J Affect Disord. 2020;269:154‐184. [Link (https://pubmed.ncbi.nlm.nih.gov/32339131/)]

Published On: 5/23/20

Duration: 1:32

Transcript:

A network meta-analysis of medications for bipolar depression just came out in the Journal of Affective Disorders. Network meta-analyses are controversial because they make a lot of assumptions as they attempt to compare therapies that have never been compared head-to-head. This paper was particularly problematic because it only looked at monotherapy studies, and bipolar depression is usually treated ─ and often studied ─ through add-on therapies. Also, they only looked at acute treatment, but in bipolar disorder the real goal is long-term prevention.

So I’ll be very judicious here and will pluck only one result that looks like it’s ready for practice.

1) Besides confirming the FDA approved treatments, they added a surprise: Depakote actually worked well in a few controlled trials of acute bipolar depression, while lithium and carbamazepine did not. It’s likely that lithium didn’t shine here because its main benefits against depression are in prevention, not acute treatment.

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