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Tiagabine in the maintenance treatment of bipolar disorders

Lookup NU author(s): Professor Allan Young, Dr Karine Macritchie, Dr Akshya Vasudev


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Background Tiagabine, ananticonvulsant, has been reported to have efficacy in prophylactic treatment of bipolar disorder incase reports and in case series. Objectives To review the efficacy and acceptability of tiagbine, relative to placebo, and other agents in the prevention and/or attenuation of episodes of bipolar affective disorder. The efficacy and acceptability of tiagabine were considered in terms of mood symptoms, mortality, general health, social functioning, adverse effects and over all acceptability to patients. Search strategy The following databases were searched on 13-10-2005. The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCR-References), EMBASE, MEDLINE, LILACS, PsycLIT and Psyndex. Reference lists of relevant papers and major text books of affective disorder were examined. Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable published or unpublished trials. Specialist journala and conference proceedings were hand searched. Selection criteria Randomised controlled trials which compare tiagabine with placebo, alternative mood stabilisers or antipsychotics, where the stated intent of intervention was the maintenance treatment of bipolar affective disorder, were sought. Bipolar patients, male and female, of all ages were to be included. Data collection and analysis Data were to be extracted from the original reports if they met our inclusion criteria. The main outcomes to be assessed were: (1) The efficacy of tiagabine treatment in preventing or attenuating further episodes of bipolar affective disorder, including its efficacy in rapid cycling disorder. (2) The acceptability of tiagabine treatment to patients. (3) The prevalence of side effects. (4) Mortality, if any, on tiagabine treatment. Outcomes concerning relapse or recurrence were to be analysed excluding data from studies using discontinuation protocols, which were to be analysed separately. Sub-group analyses were to be performed to examine the effects of tiagabine treatment in rapid cycling bipolar disorder and previous mood stabiliser non-responders. Data were to be analysed using Review Manager version 4.2.8. Main results No randomised controlled trials of tiagabine in the maintenance treatment of bipolar disorder were found. Authors' conclusions There is an insufficient methodologically rigorous evidence base to provide guidance on the use of tiagabine in the maintenance treatment of bipolar disorder. There is a need for randomised controlled trials examining the therapeutic potential of this agent in bipolar disorder, after the nature of reported episodes of syncope or seizure in tiagabine-treated bipolar patients has been established.

Publication metadata

Author(s): Young AH, Geddes JR, MacRitchie K, Rao SNK, Vasudev A

Publication type: Review

Publication status: Published

Journal: Cochrane Database of Systematic Reviews

Year: 2006

Issue: 3

Pages: CD005173

ISSN (print):

ISSN (electronic): 1469-493X


DOI: 10.1002/14651858.CD005173.pub2