Abstract
Introduction
Tamoxifen is an oral medication that has been proposed as a potential treatment for bipolar disorder. Tamoxifen acts to inhibit the intracellular action of Protein Kinase C, which is also an action of well-established treatments such as lithium and valproate.
Here we aimed to identify randomised controlled trials of tamoxifen in the treatment of bipolar disorder and synthesise their results using meta-analysis.
Methods
Randomised controlled trials were identified by searching of electronic databases and from discussion with experts in the field. Data were extracted, and meta-analyses were performed using the meta package in R.
Results
Five placebo-controlled randomised controlled trials of tamoxifen in the treatment of acute mania were identified. There were no trials in the treatment of episodes of bipolar depression, or for relapse prevention. The studies of mania treatment were of between three and six weeks duration. Tamoxifen was studied either as monotherapy (two trials) or as augmentation of lithium or valproate (three trials).
Change in mania scale scores favoured tamoxifen over placebo: SMD -2.14 (95% CI -3.39 to -.89; 4 trials). Response rates were also higher: RR 4.35 (1.99 to 9.50; 4 trials).
Acceptability was similar to placebo: RR 1.03 (0.94 to 1.13; 5 trials).
Conclusions
Tamoxifen appears to be a promising potential treatment for episodes of mania. Future studies could investigate its effects as an adjunct to antipsychotic medications for improved anti-manic efficacy, and establish its longer term effects on mood and relapse.
Financial Sponsorship: None
Tamoxifen is an oral medication that has been proposed as a potential treatment for bipolar disorder. Tamoxifen acts to inhibit the intracellular action of Protein Kinase C, which is also an action of well-established treatments such as lithium and valproate.
Here we aimed to identify randomised controlled trials of tamoxifen in the treatment of bipolar disorder and synthesise their results using meta-analysis.
Methods
Randomised controlled trials were identified by searching of electronic databases and from discussion with experts in the field. Data were extracted, and meta-analyses were performed using the meta package in R.
Results
Five placebo-controlled randomised controlled trials of tamoxifen in the treatment of acute mania were identified. There were no trials in the treatment of episodes of bipolar depression, or for relapse prevention. The studies of mania treatment were of between three and six weeks duration. Tamoxifen was studied either as monotherapy (two trials) or as augmentation of lithium or valproate (three trials).
Change in mania scale scores favoured tamoxifen over placebo: SMD -2.14 (95% CI -3.39 to -.89; 4 trials). Response rates were also higher: RR 4.35 (1.99 to 9.50; 4 trials).
Acceptability was similar to placebo: RR 1.03 (0.94 to 1.13; 5 trials).
Conclusions
Tamoxifen appears to be a promising potential treatment for episodes of mania. Future studies could investigate its effects as an adjunct to antipsychotic medications for improved anti-manic efficacy, and establish its longer term effects on mood and relapse.
Financial Sponsorship: None
| Original language | English |
|---|---|
| Article number | C45 |
| Journal | Journal of Psychopharmacology |
| Volume | 30 |
| Issue number | 8 |
| Publication status | Published - Aug 2016 |