Open AccessMaintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses
Author(s) -
Caitlin Yee,
Emily R. Hawken,
Ross J. Baldessarini,
Gustavo Vázquez
Publication year - 2019
Publication title -
international journal of neuropsychopharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.897
H-Index - 107
eISSN - 1469-5111
pISSN - 1461-1457
DOI - 10.1093/ijnp/pyz034
Subject(s) - bipolar disorder , randomized controlled trial , meta analysis , adverse effect , psychology , lithium (medication) , medicine , placebo , odds ratio , psychiatry , pediatrics , alternative medicine , pathology
Background Guidelines for maintenance treatment of juvenile bipolar disorder rely heavily on evidence from adult studies and relatively brief trials in juveniles, leaving uncertainties about optimal long-term treatment. We aimed to systematically review long-term treatment trials for juvenile bipolar disorder. Methods We analyzed data recovered by a systematic literature search using the PRISMA guidelines statement, through 2018, for peer-reviewed reports on pharmacological treatments for juvenile bipolar disorder lasting ≥24 weeks. Results Of 13 reports with 16 trials of 9 treatments (18.8% were randomized and controlled), with 1773 subjects (94.4% BD-I; ages 6.9–15.1 years), lasting 11.7 (6–22) months. Pooled clinical response rates were 66.8% (CI: 64.4–69.1) with drugs vs 60.6% (53.0–66.7) in 3 placebo-control arms. Random-effects meta-analysis of 4 controlled trials yielded pooled odds ratio (OR) = 2.88 ([0.87–9.60], P = .08) for clinical response, and OR = 7.14 ([1.12–45.6], P = .04) for nonrecurrence. Apparent efficacy ranked: combined agents >anticonvulsants ≥lithium ≥antipsychotics. Factors favoring response ranked: more attention deficit/hyperactivity disorder, polytherapy, randomized controlled trial design, nonrecurrence vs response. Adverse events (incidence, 5.50%–28.5%) notably included cognitive dulling, weight-gain, and gastrointestinal symptoms; early dropout rates averaged 49.8%. Conclusions Pharmacological treatments, including anticonvulsants, lithium, and second-generation antipsychotics, may reduce long-term morbidity in juvenile bipolar disorder. However, study number, quality, and effect magnitude were limited, leaving the status of scientific support for maintenance treatment for juvenile bipolar disorder inconclusive.