Tiagabine to treat acute affective episodes in bipolar disorder

Vasudev A, Macritchie K, Rao SNK, Geddes J, Young AH

Published Online:

January 21, 2009

This systematic review investigated the evidence base for the efficacy and acceptability of tiagabine compared to placebo and other pharmacological agents in the acute treatment of bipolar disorder. No randomised controlled trials were found. Currently, there is insufficient evidence on which to base any recommendations regarding the use of tiagabine in acute treatment of bipolar illness, either in monotherapy or as an adjunctive treatment. A significant proportion of patients suffered episodes of syncope or seizure. There is a need for randomised controlled trials examining the efficacy and acceptability of tiagabine in the acute treatment of bipolar disorder, after the nature of these episodes has been clarified.

Abstract (click to read)

Background:

Bipolar disorder is a common recurrent illness with high levels of chronicity. Treatment resistance persists despite the use of established medications, such as lithium and valproate. New medications are required for the treatment of refractory cases. Some open-label reports have suggested that the anticonvulsant tiagabine may be efficacious in bipolar disorder. There is a need to clarify the evidence available, in the form of randomised controlled trials, for its use in the treatment of acute affective episodes in bipolar disorder

Objectives:

To review the evidence for the efficacy and acceptability of tiagabine in the treatment of acute mood episodes in bipolar disorder.

Search strategy:

The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) was searched on 12/2/2008.

Reference lists of relevant papers and major textbooks of mood disorder were searched. Handsearches were done (specialist journals and conference proceedings). Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable published or unpublished trials.

Selection criteria:

Randomised controlled trials, which compared tiagabine with placebo or with active agents in the treatment of any acute mood episodes in bipolar disorder, were selected. Studies of participants with bipolar disorder were to be included. Subjects could be of either sex and of all ages.

Data collection and analysis:

Data extraction and methodological quality assessment were performed independently by two reviewers. For analysis, relative risk was used for binary efficacy outcomes and the weighted mean difference or standardised mean difference was used for continuously distributed outcomes

Main results:

We did not find any studies which fulfilled the Cochrane criteria of randomised controlled trials. However, one uncontrolled open label study and one case series were found. There were also three case reports/series of acute treatment which were continued into maintenance therapy, and one open non-randomised study with this design. The results of these studies are inconsistent .

Authors' conclusions:

We found no randomised controlled trials of tiagabine in bipolar disorder. In the reported cases, a significant proportion of patients suffered episodes of syncope or seizure. There is a need for randomised controlled trials examining the efficacy and acceptability of tiagabine in the acute treatment of bipolar disorder, after the nature of these episodes has been clarified.

This record should be cited as:

Vasudev A, Macritchie K, Rao SNK, Geddes J, Young AH. Tiagabine in the treatment of acute affective episodes in bipolar disorder. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004694. DOI: 10.1002/14651858.CD004694.pub2

Assessed as up to date:

February 12, 2008

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Primary Review Group:

Depression, Anxiety and Neurosis Group

Health topics:

Mental health > Bipolar disorder

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Tiagabine to treat acute affective episodes in bipolar disorder

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