A systematic review and meta-analysis of treatments for rapid cycling bipolar disorder

Course overview

Course Description: This course is based on material published in Acta Psychiatrica Scandinavia and is available as an open-access article. Rapid cycling is a common and disabling phenomenon in individuals with bipolar disorders. In the absence of a recent literature examination, this systematic review and meta-analysis aimed to synthesize the evidence of efficacy, acceptability and tolerability of treatments for individuals with rapid cycling bipolar disorder (RCBD).A systematic search was conducted to identify randomized controlled trials assigning participants with RCBD to pharmacological and/or non-pharmacological interventions. Study inclusion and data extraction were under- taken by two reviewers independently. The primary outcome was continuous within-subject RCBD illness severity before and after treatment. Pre-post random effects meta-analyses were conducted for each outcome/intervention arm studied, generating a standardized effect size (hedges g) and 95 percent confidence interval (CI). A total of 34 articles describing 30 studies were included. A total of 16 separate pharmacological treatments were examined in contrast to 1 psychological therapy study. Only quetiapine and lamotrigine were assessed in 5 studies. By assessing 95 percent CI overlap of within-subject efficacy effects compared to placebo, the only interventions suggesting significant depression benefits (placebo g = 0.60) were olanzapine (with/without fluoxetine; g = 1.01), citalopram (g = 1.10) and venlafaxine (g = 2.48). For mania, benefits were indicated for quetiapine (g = 1.01), olanzapine (g = 1.19) and aripiprazole (g = 1.09), versus placebo (g = 0.33). Most of these effect sizes were from only one trial per treatment. Heterogeneity between studies was variable, and 20 percent were rated to have a high risk of bias. While many interventions appeared efficacious, there was a lack of robust evidence for most treatments. Given the limited and heterogeneous evidence base, the optimal treatment strategies for people with RCBD are yet to be established. This course on treatments for bipolar disorder is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors, who do clinical work. In addition, this course is appropriate for intermediate and advanced-level practitioners who wish to develop their knowledge of treatments for bipolar disorder. The course material includes a literature review of interventions and research that may also be useful for licensed clinicians who require continuing clinical education courses for license renewal. The course is based on a journal article that includes research. It contains statistical analysis and data that some clinicians enjoy reading, and others do not. A significant benefit of reading research-based articles for continuing education is they provide practitioners with the latest findings in their field. Authors: Strawbridge, Kurana, Kerr-Gaffney, Jauhar, Kaufman, Yalin, Young Learning Objectives: This course will provide the practitioner with detailed information regarding treatments for bipolar disorder. Specifically, a professional will: Recognize diagnostic characteristics of rapid cycling bipolar disorder. Describe the efficacy, acceptability, and tolerability of treatments for rapid cycling bipolar disorder. Identify differences in treatment response for rapid cycling bipolar disorder compared to nonrapid cycling bipolar disorder. Citation: Strawbridge, R., Kurana, S., Kerr-Gaffney, J., Jauhar, S., Kaufman, K. R., Yalin, N., & Young, A. H. (2022). A systematic review and meta-analysis of treatments for rapid cycling bipolar disorder. Acta psychiatrica Scandinavica, 146(4), 290-311. https://doi.org/10.1111/acps.13471