TY - JOUR
T1 - Pharmacological treatment of mood disorders and co-morbid addictions: a systematic review and meta-analysis
AU - Stokes, Paul
AU - Jokinen, T
AU - Amawi, Sami
AU - Moqueet Qureshi, Mutahira
AU - Husain, Muhammad I.
AU - Yatham, Lakshmi N.
AU - Strang, John S
AU - Young, Allan
PY - 2020/2/17
Y1 - 2020/2/17
N2 - Objective: Addiction co-morbidity is an important clinical challenge in mood disorders but the best way of pharmacologically treating people with mood disorders and addictions remains unclear. The aim of this study was to assess the efficacy of pharmacological treatments for mood and addiction symptoms in mood disorders with addiction co-morbidity. Methods: A systematic search of placebo-controlled, randomised controlled trials investigating the effects of pharmacological treatments in people with bipolar disorder (BD) or major depressive disorder (MDD) and co-morbid addictions was performed. Treatment related effects on mood and addiction measures were assessed in a meta-analysis which also estimated risks of participant drop-out and adverse effects. Results: 32 studies met systematic review inclusion criteria. Pharmacological therapy was more effective than placebo for improving manic symptoms (SMD=-0.15, 95% CI -0.29 to -0.02, p=0.03) but not BD depressive symptoms (SMD=-0.09, 95% CI -0.22 to 0.03, p=0.15). Quetiapine significantly improved manic symptoms (SMD=-0.23, 95% CI -0.39 to -0.06, p=0.008) but not BD depressive symptoms (SMD=-0.07, 95% CI -0.23 to 0.10, p=0.42). Pharmacological therapy was more effective than placebo for improving depressive symptoms in MDD (SMD= -0.16, 95% CI -0.30 to -0.03, p=0.02). Imipramine improved MDD depressive symptoms (SMD=-0.58, 95% CI -1.03 to -0.13, p=0.01) but SSRI based treatments had no effect (SMD=--0.06, 95% CI -0.30 to 0.17, p=0.60). Pharmacological treatment improved the odds of alcohol abstinence in MDD but had no effects on opiate abstinence. Conclusions: Pharmacological treatments were significantly better than placebo in improving manic symptoms, MDD depressive symptoms and alcohol abstinence but were not better for bipolar depression symptoms. Importantly, quetiapine was not more effective than placebo in improving bipolar depression symptoms nor were SSRI’s for the treatment of MDD depression. Our findings highlight the need for further high-quality clinical trials of treatments for mood disorders and co-morbid addictions.
AB - Objective: Addiction co-morbidity is an important clinical challenge in mood disorders but the best way of pharmacologically treating people with mood disorders and addictions remains unclear. The aim of this study was to assess the efficacy of pharmacological treatments for mood and addiction symptoms in mood disorders with addiction co-morbidity. Methods: A systematic search of placebo-controlled, randomised controlled trials investigating the effects of pharmacological treatments in people with bipolar disorder (BD) or major depressive disorder (MDD) and co-morbid addictions was performed. Treatment related effects on mood and addiction measures were assessed in a meta-analysis which also estimated risks of participant drop-out and adverse effects. Results: 32 studies met systematic review inclusion criteria. Pharmacological therapy was more effective than placebo for improving manic symptoms (SMD=-0.15, 95% CI -0.29 to -0.02, p=0.03) but not BD depressive symptoms (SMD=-0.09, 95% CI -0.22 to 0.03, p=0.15). Quetiapine significantly improved manic symptoms (SMD=-0.23, 95% CI -0.39 to -0.06, p=0.008) but not BD depressive symptoms (SMD=-0.07, 95% CI -0.23 to 0.10, p=0.42). Pharmacological therapy was more effective than placebo for improving depressive symptoms in MDD (SMD= -0.16, 95% CI -0.30 to -0.03, p=0.02). Imipramine improved MDD depressive symptoms (SMD=-0.58, 95% CI -1.03 to -0.13, p=0.01) but SSRI based treatments had no effect (SMD=--0.06, 95% CI -0.30 to 0.17, p=0.60). Pharmacological treatment improved the odds of alcohol abstinence in MDD but had no effects on opiate abstinence. Conclusions: Pharmacological treatments were significantly better than placebo in improving manic symptoms, MDD depressive symptoms and alcohol abstinence but were not better for bipolar depression symptoms. Importantly, quetiapine was not more effective than placebo in improving bipolar depression symptoms nor were SSRI’s for the treatment of MDD depression. Our findings highlight the need for further high-quality clinical trials of treatments for mood disorders and co-morbid addictions.
M3 - Article
SN - 0706-7437
JO - Canadian Journal of Psychiatry
JF - Canadian Journal of Psychiatry
ER -