Pharmacological treatment of mixed states

TY - JOUR

T1 - Pharmacological treatment of mixed states

AU - Cuomo, Alessandro

AU - Nikolova, Viktoriya L.

AU - Yalin, Nefize

AU - Arnone, Danilo

AU - Fagiolini, Andrea

AU - Young, Allan H.

PY - 2017/4/18

Y1 - 2017/4/18

N2 - Mixed states in bipolar disorder have been neglected, and the data concerning treatment of these conditions have been relatively obscure. To address this, we systematically reviewed published pharmacological treatment data for “mixed states/episodes” in mood disorders, including “with mixed features” in DSM–5. We searched PubMed, MEDLINE, The Cochrane Library, clinicaltrials.gov, and controlled-trials.com (with different combinations of the following keywords: “mixed states/features,” “bipolar,” “depressive symptoms/bipolar depression,” “manic symptoms,” “treatment,” “DSM–5”) through to October 2016. We applied a quality-of-evidence approach: first-degree evidence=randomized placebo-controlled studies of pharmacological interventions used as monotherapy; second-degree evidence=a similar design in the absence of a placebo or of a combination therapy as a comparative group; third-degree evidence=case reports, case series, and reviews of published studies. We found very few primary double-blind, placebo-controlled studies on the treatment of mixed states: the preponderance of available data derives from subgroup analysis performed on studies that originally involved manic patients. Future research should study the effects of treatments in mixed states defined using current criteria.

AB - Mixed states in bipolar disorder have been neglected, and the data concerning treatment of these conditions have been relatively obscure. To address this, we systematically reviewed published pharmacological treatment data for “mixed states/episodes” in mood disorders, including “with mixed features” in DSM–5. We searched PubMed, MEDLINE, The Cochrane Library, clinicaltrials.gov, and controlled-trials.com (with different combinations of the following keywords: “mixed states/features,” “bipolar,” “depressive symptoms/bipolar depression,” “manic symptoms,” “treatment,” “DSM–5”) through to October 2016. We applied a quality-of-evidence approach: first-degree evidence=randomized placebo-controlled studies of pharmacological interventions used as monotherapy; second-degree evidence=a similar design in the absence of a placebo or of a combination therapy as a comparative group; third-degree evidence=case reports, case series, and reviews of published studies. We found very few primary double-blind, placebo-controlled studies on the treatment of mixed states: the preponderance of available data derives from subgroup analysis performed on studies that originally involved manic patients. Future research should study the effects of treatments in mixed states defined using current criteria.

KW - depressive symptoms

KW - DSM–5

KW - manic symptoms

KW - Mixed states/episodes

KW - mood disorders

KW - pharmacological interventions

KW - pharmacotherapies

KW - treatment

UR - http://www.scopus.com/inward/record.url?scp=85017503487&partnerID=8YFLogxK

U2 - 10.1017/S1092852917000013

DO - 10.1017/S1092852917000013

M3 - Article

AN - SCOPUS:85017503487

SN - 1092-8529

VL - 22

SP - 186

EP - 195

JO - CNS SPECTRUMS

JF - CNS SPECTRUMS

IS - 2

ER -