Manic switches induced by antidepressants: an umbrella review comparing randomized controlled trials and observational studies. (23rd November 2016)

• Record Type: Journal Article
• Authors: Allain, N.; Leven, C.; Falissard, B.; Allain, J.‐S.; Batail, J.‐M.; Polard, E.; Montastruc, F.; Drapier, D.; Naudet, F.
• Is Part Of: Acta psychiatrica Scandinavica. Volume 135:Number 2(2017:Feb.)
• Page Start: 106
• Page End: 116
• Publication Date: 2016-11-23
• Subjects: meta‐analysis -- randomized controlled trial -- affective disorders -- depression; Psychiatry -- Periodicals; 616.89
• DOI: 10.1111/acps.12672
• Languages: English
• ISSNs: 0001-690X

Abstract

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.