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Tamoxifen shows the best efficacy in adults with acute bipolar mania, followed by its combination with Lithium or Valproate.
A recent systematic review and network meta-analysis (NMA) published in “Molecular Psychiatry” has revealed that Tamoxifen, both alone and in combination with Lithium or Valproate, is highly effective in treating acute bipolar mania. Acute bipolar mania poses a significant challenge in pharmacological management, with limited comparative evidence on the effectiveness, safety, and tolerability of available treatments. Hence, Wenbo Huang and colleagues sought to address this gap by systematically evaluating all currently used medications for acute bipolar mania, providing crucial insights into their relative benefits and risks.
Researchers performed this study with the aid of R software, reviewing randomized controlled trials on efficiency (mean alteration from baseline to endpoint in mania assessment scores), safety (clinically relevant adverse outcomes from baseline to therapy conclusion), and tolerability (the percentage of individuals who finished the whole trial as intended) of pharmacological treatments for acute bipolar mania from 113 studies involving 23,491 volunteers. The enrolled subjects were randomly distributed across 51 monotherapy options, adjunctive treatments, or a placebo.
It was observed that Tamoxifen (mean difference [MD] -22.31) and Tamoxifen combined with Lithium or Valproate (MD -16.37) were most effective compared to placebo. Also, antipsychotics (Olanzapine, Paliperidone, Quetiapine, Ziprasidone, Risperidone, Haloperidol) and Divalproex were better tolerated than placebo. Additionally, the combination therapies of antipsychotics with Lithium or Valproate exhibited greater effectiveness than monotherapies. No increased incidence of headache or depression was noted compared to the placebo, though specific adverse events were associated with pharmacotherapies.
Molecular Psychiatry
Comparative efficacy, safety, and tolerability of pharmacotherapies for acute mania in adults: a systematic review and network meta-analysis of randomized controlled trials
Wenbo Huang et. al.
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