Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-analyses

Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-analyses

Yee, C. S. Hawken, E. R. Baldessarini, R. J. Vazquez, G. H.
International Journal of Neuropsychopharmacology
BACKGROUND: Guidelines for maintenance treatment of juvenile bipolar disorder (jBD) rely heavily on evidence from adult studies and relatively brief trials in juveniles, leaving uncertainties about optimal long-term treatment. We aimed to systematically review long-term treatment trials for jBD. METHODS: We analyzed data recovered by systematic literature searching using PRISMA guidelines statement, through 2018, for peer-reviewed reports on pharmacological treatments for jBD lasting >=24-weeks. RESULTS: Of 13 reports with 16 trials of 9 treatments, 18.8% were randomized-controlled [RCTs]) with 1773 subjects (94.4% BD-I; ages 6.9-15.1 years), lasting 11.7 (6-22) months. Pooled clinical response rates were 66.8% [CI: 64.4-69.1] with drugs vs. 60.6% [53.0-66.7] in 3 placebo-control arms. Random-effects meta-analysis of 4 controlled trials yielded pooled OR=2.88 ([0.87-9.60], p=0.08) for clinical response, and OR=7.14 ([1.12-45.6], p=0.04) for nonrecurrence. Apparent efficacy ranked: combined agents > anticonvulsants >= lithium >= antipsychotics. Factors favoring response ranked: more ADHD, polytherapy, RCT design, nonrecurrence vs. response. Adverse-events (incidence, 5.50%-28.5%), notably included cognitive dulling, weight-gain, and gastrointestinal symptoms; early dropout rates averaged 49.8%. CONCLUSIONS: Pharmacological treatments, including anticonvulsants, lithium, and second-generation antipsychotics may reduce long-term morbidity in jBD. However, study number, quality, and effect-magnitude were limited, leaving scientific support for maintenance treatment for jBD inconclusive.

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