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Review: mood stabilisers monotherapy as effective as combination therapy for treatment of acute bipolar depression in studies with some limitations

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What are the effects of mood stabiliser monotherapy (MTM) compared with combination and antidepressant treatment in people with acute bipolar depression?


Clinical response measured by ≥50% reduction in Montgomery-Asberg Depression Rating Scale (MADRS) or ≥50% reduction in Hamilton Rating Scale for Depression (HRSD) or much, or very much, improved on the Clinical Global Impressions – Improvement scale; symptom remission: endpoint MADRS ≤12, endpoint score of <9 on the HRSD plus a 50% reduction; acceptability (all-cause discontinuation); affective switch (Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR) criteria); suicidal behaviour and clinically significant weight gain.



Systematic review with meta-analysis.

Data sources

MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library and the clinical trial database ( were searched from inception to January 2008 for randomised controlled trials (RCTs). Reference lists of identified studies were reviewed. Eight key journals were hand searched till April 2008.

Study selection and analysis

Two reviewers appraised studies and selected RCTs comparing mood stabilisers with placebo, combination therapy (mood stabilisers plus augmenting agent) or antidepressant add-on or monotherapy in adults (aged 18–65 years) with bipolar disorder and acute major depression (DSM-IV). Only treatments given to reduce an …

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  • Sources of funding Not stated.


  • Competing interests RHP has received consulting fees or honoraria from AstraZeneca, Bristol Myers-Squibb, Pfizer, Eli Lilly and Co, Glaxo SmithKline, Proteus Biomedical and Concordant Rater Systems. RHP receives royalties and holds equity in Concordant Rater Systems.

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