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Manic switches induced by antidepressants: an umbrella review comparing randomized controlled trials and observational studies.
- Source :
-
Acta Psychiatrica Scandinavica . Feb2017, Vol. 135 Issue 2, p106-116. 11p. - Publication Year :
- 2017
-
Abstract
- Objective We aimed to explore whether the prevalence of manic switch was underestimated in randomized controlled trials ( RCTs) compared to observational studies ( OSs). Method Meta-analyses and simple and systematic reviews were identified by two reviewers in a blinded, standardized manner. All relevant references were extracted to include RCTs and OSs that provided data about manic switch prevalence after antidepressant treatment for a major depressive episode. The primary outcome was manic switch prevalence in the different arms of each study. A meta-regression was conducted to quantify the impact of certain variables on manic switch prevalence. Results A total of 57 papers (35 RCTs and 22 OSs) were included in the main analysis. RCTs underestimated the rate of manic switch [0.53 (0.32-0.87)]. Overestimated prevalence was related to imipraminics [1.85 (1.22-2.79)]; to serotonin-norepinephrine reuptake inhibitors [1.74 (1.06-2.86)]; and to other classes of drugs [1.58 (1.08-2.31)], compared to placebo treatment. The prevalence of manic switch was lower among adults than among children [0.2 (0.07-0.59)]; and higher [20.58 (8.41-50.31)] in case of bipolar disorder. Conclusion Our results highlight an underestimation of the rates of manic switch under antidepressants in RCTs compared to the rates observed in observational studies. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 0001690X
- Volume :
- 135
- Issue :
- 2
- Database :
- Academic Search Index
- Journal :
- Acta Psychiatrica Scandinavica
- Publication Type :
- Academic Journal
- Accession number :
- 120504893
- Full Text :
- https://doi.org/10.1111/acps.12672