Bipolar Disorders最新文献

{"title":"Do Patients Comply With 12-h Lithium Blood Level Timing? Findings From a Controlled Clinical Trial and a Real-World Clinical Setting.","authors":"Søren L Jacobsen, Christian L Kraft, Andrew A Nierenberg, Torben A Devantier, Ole Köhler-Forsberg","doi":"10.1111/bdi.70060","DOIUrl":"https://doi.org/10.1111/bdi.70060","url":null,"abstract":"<p><strong>Background: </strong>Lithium blood levels are measured routinely 12 h after lithium dosing, but no study has evaluated the actual compliance of patients with the 12-h levels.</p><p><strong>Methods: </strong>First, we used the US multicenter clinical trial \"Bipolar CHOICE\" (n = 145 patients treated with lithium with N = 287 lithium blood tests), where participants reported the time since the last lithium dose at lithium blood tests. Second, we included all lithium blood tests (3179 individuals, 52,837 blood tests) from hospitals and private practitioners in the Central Denmark Region (CDR, approximate population 1.3 million) during 2012-2022, including the time of lithium blood tests and the registered time when patients were supposed to take their lithium dose.</p><p><strong>Results: </strong>In Bipolar CHOICE, participants took the lithium blood test at a mean/median of 12.8/12 h (SD = 9.1, IQR = 10.5-14) after the lithium dose, but the range was 0.5-120 h and 44.9% had the blood test taken < 10 or > 14 h after the lithium dose. Those with a blood test > 14 h after the lithium dose had significantly lower lithium levels (0.41 vs. 0.64). In the CDR, the mean/median time was 14.5/13.7 (SD = 3.8, IQR = 12.0-15.8) and 49.7% had the blood test taken < 10 or > 14 h after the supposed intake of lithium. Those with > 16 h between lithium intake and the lithium blood test were more often followed by general practitioners and showed higher creatinine concentrations.</p><p><strong>Conclusions: </strong>Approximately half of lithium blood tests do not comply with guideline-based recommendations for 12-h trough levels, emphasizing the need for solutions to solve this clinical need.</p>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide Deaths in People With Bipolar Disorder: Characteristics and Treatments at Time of Death.","authors":"Ayal Schaffer, Prudence Po Ming Chan, Vera Yu Men, Rosalie Steinberg, Rachel Hb Mitchell, Gin Malhi, Lakshmi N Yatham, Mark Sinyor","doi":"10.1111/bdi.70061","DOIUrl":"https://doi.org/10.1111/bdi.70061","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare suicide deaths in those with or without bipolar disorder (BD), taking into particular consideration the degree to which treatment at the time of death, according to toxicology data, reflects evidence-based pharmacotherapy.</p><p><strong>Methods: </strong>Coroner data were coded for all verified suicide deaths in the City of Toronto, Canada (1998-2020). Suicide decedents with BD (n = 340) were compared to the non-BD group (n = 4948) on demographic, clinical, and suicide-related variables. In a subsample of decedents, the presence and/or lethality of medications or substances at the time of death was identified from toxicology data and compared between groups and across time (two 11.5 year epochs). Data were analyzed using univariate analyses.</p><p><strong>Results: </strong>Several noteworthy demographic, clinical, and suicide-specific differences between BD and non-BD suicide groups emerged. Antidepressants (48.9%) and benzodiazepines (46.7%) were the most commonly present medications among people with BD, at a proportion similar to the non-BD group. There was a significant decrease in the presence of mood stabilizers across time (33.3% vs. 13.5%, p = 0.006), and lithium was present in only 5.8% of decedents with BD. Opioids (22.1%) and antipsychotics (22.1%) were the most common substances detected in lethal amounts in the BD group.</p><p><strong>Conclusions: </strong>The findings of this study suggest that a substantial proportion of people with BD who die by suicide are not receiving first-line treatments at the time of death. While causality cannot be established, further exploration of pharmacotherapy at the time of death would ideally link to living controls to address issues of risk and lethality.</p>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choices of Artificial Intelligence (AI): ChatGPT's Solutions to Ethical Dilemmas in Bipolar Disorder Care.","authors":"Russell Franco D'Souza, Krishna Mohan Surapaneni, Mary Mathew, Shabbir Amanullah, Rajiv Tandon","doi":"10.1111/bdi.70059","DOIUrl":"https://doi.org/10.1111/bdi.70059","url":null,"abstract":"<p><strong>Background: </strong>Bipolar disorders present complex ethical challenges to patient care due to the delicate balance between patient autonomy and safety. The use of artificial intelligence (AI), particularly ChatGPT, holds the potential to address these dilemmas by providing personalized treatment plans, monitoring patient well-being, and reducing stigma associated with mental health issues. However, the application of AI in this context requires a deep understanding of the unique needs and vulnerabilities of individuals with bipolar disorder.</p><p><strong>Methods: </strong>This experimental study evaluated ChatGPT's (Version 3.5) responses to ethical dilemmas in bipolar disorder care using three clinical case scenarios reported in an open-access publication. The study compared ChatGPT's answers to an original answer key from the article. ChatGPT's responses were cross-checked and analyzed for alignment with the explanation given in the article.</p><p><strong>Results: </strong>ChatGPT provided mostly congruent responses with the original answer key, demonstrating its potential to offer insights and considerations for ethical dilemmas. However, there were variations in some responses, emphasizing the complexity of ethical decision-making in healthcare. These findings underscore the importance of combining AI-generated insights with human expertise in complex medical and ethical situations.</p><p><strong>Conclusion: </strong>ChatGPT, and similar AI systems, can be valuable resources for addressing ethical concerns in bipolar disorder care. They offer guidance and information to clinicians, patients, and stakeholders, contributing to shared decision-making in healthcare. Nonetheless, the study highlights the essential role of human judgment and expertise in navigating intricate ethical dilemmas. Continuous research and development are necessary to enhance ChatGPT's capabilities and ensure responsible use, aligning AI assistance with the highest standards of patient care and ethical conduct.</p>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Common Cause of ADHD and Bipolar Disorder (BD)","authors":"Rabinovitch Avinoam,&nbsp;Rabinovitch Revital,&nbsp;Braunstein Doron,&nbsp;Smolik Ella,&nbsp;Biton Yaacov","doi":"10.1111/bdi.70057","DOIUrl":"10.1111/bdi.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Bipolar and ADHD are two diseases that exhibit similar traits but at different levels of severity. Understanding this behavior can help treatment of these disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We hypothesize that there is a common partial genetic cause for both attention-deficit/hyperactivity disorder (ADHD) and bipolar disorders (BD), which is the reversal function of the dopamine neurotransporter DAT gate (see Figure 1) into an efflux mode. We analyze the dopamine chemistry in the neuron synapse under this assumption.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The difference between ADHD and BD phenotypes is due either to the dopamine receptor (D2R) operation or to the threshold levels of the dopamine homeostatic control and the intensity of its operation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>The common cause of the two disorders could explain the frequent phenomenon of ADHD symptoms preceding BD beginning and the high comorbidity between these disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 6","pages":"472-475"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the Complement C3-Hippocampus Pathway in Relation With Mood Symptoms in Offspring of Parents With Bipolar Disorder","authors":"Shiyun Wu,&nbsp;Zhongwan Liu,&nbsp;Robin Shao,&nbsp;Wenjin Zou,&nbsp;Xiaoyue Li,&nbsp;Weicong Lu,&nbsp;Jinyong Chen,&nbsp;Suk-Yu Yau,&nbsp;Kangguang Lin","doi":"10.1111/bdi.70056","DOIUrl":"10.1111/bdi.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Accumulative research indicates key roles of the peripheral inflammation system and hippocampal function in major mood disorders. The complement system modulates inflammatory function and is abnormal in mood disorders, but its precise neural pathway remains unclear. This study investigates the interrelations among complement component 3 (C3) levels, hippocampal function, and mood symptoms among offspring of bipolar disorder (BD) parents who carry familial risk of mood disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We recruited unaffected BD offspring with (symptomatic offspring, SO, <i>N</i> = 31) or without (asymptomatic offspring, AO, <i>N</i> = 39) subthreshold symptoms, and matched healthy controls (HC, <i>N</i> = 41). Peripheral C3 levels were measured, and resting-state fMRI was conducted to assess hippocampal functional connectivity (FC). Spectral dynamic causal modeling (spDCM) was conducted to verify the directionality of the hippocampal FC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The SO group exhibited significantly lower peripheral C3 levels (<i>F</i>_2,108 = 23.651, <i>p</i> &lt; 0.001) and reduced left hippocampus-left cerebellum FC (<i>F</i>_2,108 = 8.541, <i>p</i> &lt; 0.001) compared to both the AO and HC groups. Furthermore, the left hippocampus-left cerebellum FC partially mediated the relationship between C3 levels and depressive symptoms in the SO group (bootstrapping 95% CI = −4.1168 to −0.1569), but not in AO (bootstrapping 95% CI = −0.3479 to 0.1317) or HC (bootstrapping 95% CI = −0.3297 to 0.0885). The left hippocampus-left cerebellum FC was bidirectional in all 3 groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings indicate a C3-hippocampus-depressive symptom pathway might underpin the particular high vulnerability of individuals with both familial and symptomatic risks of mood disorders. This evidence provides new neuroinflammatory markers and targets for early identification and intervention of these individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 6","pages":"461-471"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Causal Effects of Gut Microbiome on Bipolar Disorder.","authors":"Qian Zhao, Hongbao Cao, Ancha Baranova, Fuquan Zhang","doi":"10.1111/bdi.70063","DOIUrl":"https://doi.org/10.1111/bdi.70063","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown that gut microbiome dysbiosis has pathogenic significance in the development of bipolar disorder (BD), but the direct causal relationship remains unclear. We aimed to investigate this potential correlation.</p><p><strong>Methods: </strong>Using a two-sample Mendelian randomization (TSMR) analysis, we examined the potential causal effects of gut microbiota on BD. Summary results for gut microbiota were derived from two large genome-wide association studies (GWAS) on gut microbiota: the MibioGen consortium (N = 18,340) and the Dutch Microbiome Project (N = 8208), as well as one GWAS summary result for BD (N = 413,466).</p><p><strong>Results: </strong>Our TSMR analysis revealed that the levels of 12 taxa were associated with a reduced risk of BD. These included the phylum Bacteroidetes, its class Bacteroidia, its order Bacteroidales, its species Parabacteroides johnsonii and Paraprevotella unclassified, and genus Faecalibacterium (OR: 0.85 ~ 0.96, p ≤ 0.043). Conversely, 11 gut bacterial taxa were linked to an increased risk of BD. These comprised the class Betaproteobacteria, its order Burkholderiales, and its family Sutterellaceae (OR: 1.06 ~ 1.25, p ≤ 0.049).</p><p><strong>Conclusions: </strong>Our study further identifies a genetic link between BD and gut microbiota. The causal effects of certain gut microbiota on BD may bring potential clinical benefits and provide a new paradigm for the prevention and treatment of BD.</p>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disentangling Subjective Sleep and Objective Cognition: Insights From Two Independent Cross-Sectional Cohorts of Remitted Bipolar Disorder","authors":"Jeff Zarp,&nbsp;Hanne Lie Kjærstad,&nbsp;Maria Nesje Porten,&nbsp;Lars Vedel Kessing,&nbsp;Kamilla Woznica Miskowiak","doi":"10.1111/bdi.70051","DOIUrl":"10.1111/bdi.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Cognitive impairment during remission in bipolar disorder (BD) hampers functional recovery. While diverse factors can impact these impairments, sleep disturbance is considered a key component. This cross-sectional report aimed to analyze the association between subjective sleep characteristics and objective cognitive impairment in two independent samples of remitted outpatients with BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Baseline data, including neuropsychological test performances and questionnaire-based sleep quality, subjective cognitive complaints, and mood ratings, were pooled from two clinical trials. Eighteen- to sixty-four-year-old fully or partially remitted outpatients with BD were divided into two independent cohorts: (i) newly diagnosed patients classified as cognitively impaired (<i>n</i> = 40) or normal (<i>n</i> = 58) according to hierarchical cluster analysis and matching healthy controls (HC) (<i>n</i> = 80), as well as (ii) patients with longer duration of illness prescreened for cognitive impairment (<i>n</i> = 115) and matching HC (<i>n</i> = 75). Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Correlational and multiple linear regression analyses investigated associations between cognition and sleep.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In age-, sex-, and medication-adjusted regression analyses, subjectively reported sleep quality (PSQI total score) was not associated with objective cognitive impairment globally or across domains in any cohort. Instead, worse subjective sleep quality was associated with more subjective cognitive complaints, greater subsyndromal depression symptoms, and receiving antipsychotic medication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings support the view that objective cognitive impairments in remitted patients with BD, whether newly diagnosed or with longer illness duration, may not be solely attributable to subjectively reported sleep disturbances. This adds to emerging evidence suggesting cognition as a relevant treatment target in BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 6","pages":"435-448"},"PeriodicalIF":4.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Sleep Parameters Predict Upcoming Mood Episodes in Bipolar Disorder?","authors":"Andrea Ulrichsen,&nbsp;Esther Mühlbauer,&nbsp;Lisa-Marie Hartnagel,&nbsp;Emanuel Severus,&nbsp;Anthony Cleare,&nbsp;Sameer Jauhar,&nbsp;Michael Bauer,&nbsp;Ulrich Ebner-Priemer","doi":"10.1111/bdi.70054","DOIUrl":"10.1111/bdi.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bipolar disorder (BD) is a recurrent disorder, characterised by episodes of (hypo)mania, depression and euthymia with variation in mood, cognition and sleep. Many patients identify changes in sleep before an episode; using daily sleep logs could help identify these changes. Such early warning signs can be a valuable tool for patients and clinicians alike in predicting and preparing for changes in mood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the BipoSense study, we followed patients with BD, who were in remission at the start of the study, daily for 1 year. Patients reported for each hour if they were awake or asleep through an app and received fortnightly clinical assessments of bipolar symptoms. We used statistical analyses applying person-centred data in multilevel logit models to investigate if sleep patterns could differentiate between the period before an episode (prodromal stage) and euthymia, looking at both mean changes and variability of sleep. Bonferroni-Holm corrections were applied to avoid inflation of type I errors from multiple testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine participants were included (mean age 44.0 years [SD = 11.9], female 55% and BD-I 59%). Waking up later was associated with prodromal depression and was the only significant finding for prodromal mood episodes. Greater variability of sleep duration, total time spent in bed and time waking up were associated with prodromal depression; less variability of time falling asleep and time waking up were linked with prodromal (hypo)mania.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Using self-assessed sleep changes and especially variability can be potential tools in helping patients identify early warning signs of mood recurrence; however, these analyses were explorative and further investigations are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 6","pages":"449-460"},"PeriodicalIF":4.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting Emotion Regulation in Psychological Therapy for Bipolar Disorder: A Viable Approach?","authors":"Luisa de Siqueira Rotenberg,&nbsp;Harriet Birabwa-Oketcho,&nbsp;Kathryn E. Lewandowski,&nbsp;David J. Miklowitz,&nbsp;Sarah H. Sperry,&nbsp;Kim Wright","doi":"10.1111/bdi.70052","DOIUrl":"10.1111/bdi.70052","url":null,"abstract":"","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 6","pages":"409-410"},"PeriodicalIF":4.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Pharmacological Interventions in the Treatment of Major Depressive Disorder and Bipolar Depression With Mixed Features: A Systematic Review","authors":"Naomi Xiao,&nbsp;Liyang Yin,&nbsp;Serene Lee,&nbsp;Kayla M. Teopiz,&nbsp;Sabrina Wong,&nbsp;Gia Han Le,&nbsp;Sebastian Badulescu,&nbsp;Heidi Ka. Ying. Lo,&nbsp;Maj Vinberg,&nbsp;Bing Cao,&nbsp;Iria Grande,&nbsp;Joshua D. Rosenblat,&nbsp;Roger S. McIntyre","doi":"10.1111/bdi.70049","DOIUrl":"10.1111/bdi.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is a need to provide up-to-date, clinically translatable data as it relates to the treatment of a major depressive episode (MDE) with mixed features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed and OVID were searched from inception to July 22, 2024. Randomized controlled trials (RCTs) investigating the efficacy of pharmacological agents for adults with bipolar disorder (BD) or major depressive disorder (MDD) in an MDE with mixed features were included. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomized Studies (RoB2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of seven studies were included in this systematic review. The studies identified were all short-term acute studies ranging from 6 to 8 weeks. Treatment with lurasidone, olanzapine, cariprazine, lumateperone, quetiapine, and ziprasidone was associated with statistically significant reduction of depressive symptoms in MDEs with mixed features. Only lumateperone is studied in both BD subtypes [bipolar I disorder (BD-I), bipolar II disorder (BD-II)] and MDD, wherein efficacy in mixed features was the prespecified primary outcome. Lurasidone has a single study in MDD, while ziprasidone has data in a mixed sample of BD-II and MDD. Data for the other agents in mixed features is post hoc. Co-occurring hypomanic symptoms generally improved, and there was no significant difference between the above treatments and placebo with respect to hypomanic symptom severity intensification or treatment-emergent affective switching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Select atypical antipsychotics are effective in alleviating depressive symptoms in persons with mixed features; albeit, much of the data is obtained from post hoc analysis. Minimal evidence exists for the efficacy of lithium or valproate in the treatment of depressive episodes with mixed features. Antidepressant monotherapy has not been adequately evaluated in depressive episodes with mixed features. In addition, there is a pressing need for a consistent definition of mixed presentations to guide future interventional studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 5","pages":"347-357"},"PeriodicalIF":4.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}