Prescribed psychostimulants and other pro-cognitive medications in bipolar disorder: A systematic review and meta-analysis of recurrence of manic symptoms

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2024-04-26 DOI:10.1111/bdi.13440

Andreea Chiorean, Brett D. M. Jones, Mijia Murong, Christina Gonzalez-Torres, Stefan Kloiber, Abigail Ortiz, Joshua D. Rosenblat, Benoit H. Mulsant, M. Ishrat Husain

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引用次数: 0

Abstract

Objectives

Clinicians are often hesitant to prescribe psychostimulants in bipolar disorder (BD) due to concerns of inducing (hypo)mania, despite limited published evidence on associations between prescribed psychostimulant use and recurrence of mood episodes in BD. The current systematic review and meta-analysis evaluated the emergence of (hypo)manic symptoms in patients with BD receiving prescribed psychostimulants or other pro-cognitive medications in euthymic or depressive states.

Methods

A systematic search was performed of MEDLINE, Embase, and PsychINFO from inception to April 5, 2023 and search of Clinicaltrials.gov and Clinicaltrialsregister.eu for unpublished data. References of included studies were hand-searched. Randomized trials and prospective longitudinal studies that evaluated psychostimulants and non-stimulant medications recommended for the treatment of ADHD by the Canadian ADHD practice guidelines were included. The review was reported in line with PRISMA guidelines and was preregistered on PROSPERO (CRD42022358588).

Results

After screening 414 unique records, we included 27 studies, of which five reported data that was quantitatively synthesized (n = 1653). The use of psychostimulants in BD was not associated with increased scores on the Young Mania Rating Scale in patients who were in a euthymic or depressed state (SMD IV −0.17; 95% CI, −0.40 to 0.06) compared to placebo. There was a high degree of study-level heterogeneity (I² = 80%). A qualitative synthesis of studies revealed a limited risk of medication-induced manic symptoms.

Conclusions

Our review provides preliminary evidence to suggest psychostimulants and non-stimulant ADHD medications have a limited risk of precipitating (hypo)mania symptoms. More extensive studies evaluating the safety and efficacy of these medications are warranted.

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查看原文本刊更多论文

双相情感障碍患者的处方精神兴奋剂和其他促进认知的药物：躁狂症状复发的系统回顾和荟萃分析

由于担心会诱发（低）躁狂症，临床医生在为双相情感障碍（BD）患者开具精神刺激剂处方时往往犹豫不决，尽管已发表的有关精神刺激剂处方使用与双相情感障碍患者情绪发作复发之间关系的证据有限。本系统综述和荟萃分析评估了在优郁或抑郁状态下接受精神刺激剂或其他促认知药物治疗的躁狂症患者出现（低）躁狂症状的情况。

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.