論文 - 高江洲　義和

Development and acceptability testing of a decision aid for considering whether to reduce antipsychotics in individuals with stable schizophrenia.

Aoki Y, Takaesu Y, Matsui K, Tokumasu T, Tani H, Takekita Y, Kanazawa T, Kishimoto T, Tarutani S, Hashimoto N, Takeuchi H, Mishima K, Inada K

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )    2023年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

AIM: Continued antipsychotic treatment is the key to preventing relapse. Maintenance antipsychotic monotherapy and optimal dose use are recommended for individuals with stable schizophrenia because of their undesirable effects. Decision aids (DAs) are clinical conversation tools that facilitate shared decision-making (SDM) between patients and health-care providers. This study aimed to describe the development process and results of acceptability testing of a DA for individuals with stable schizophrenia, considering (i) whether to continue high-dose antipsychotics or reduce to the standard dose and (ii) whether to continue two antipsychotics or shift to monotherapy. METHODS: A DA was developed according to the guidelines for the appropriate use of psychotropic medications and International Patient Decision Aid Standards (IPDAS). First, a DA prototype was developed based on a previous systematic review and meta-analysis conducted for identifying the effects of continuing or reducing antipsychotic treatment. Second, mixed-method survey was performed among individuals with schizophrenia and health-care providers to modify and finalize the DA. RESULTS: The DA consisted of an explanation of schizophrenia, options to continue high-dose antipsychotics or reduce to the standard dose, options to continue two antipsychotics or shift to monotherapy, pros and cons of each option, and a value-clarification worksheet for each option. The patients (n = 20) reported acceptable language use (75%), adequate information (75%), and well-balanced presentation (79%). Health-care providers (n = 20) also provided favorable overall feedback. The final DA covered six IPDAS qualifying criteria. CONCLUSION: A DA was successfully developed for schizophrenia, considering whether to reduce antipsychotics, which can be used in the SDM process.

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Combination Psychotropic Use for Schizophrenia With Long-Acting Injectable Antipsychotics and Oral Antipsychotics: A Nationwide Real-World Study in Japan.

Onitsuka T, Okada T, Hasegawa N, Tsuboi T, Iga JI, Yasui-Furukori N, Yamada N, Hori H, Muraoka H, Ohi K, Ogasawara K, Shinichiro O, Takeshima M, Ichihashi K, Fukumoto K, Iida H, Yamada H, Furihata R, Makinodan M, Takaesu Y, Numata S, Komatsu H, Hishimoto A, Kido M, Atake K, Yamagata H, Kikuchi S, Hashimoto N, Usami M, Katsumoto E, Asami T, Kubota C, Matsumoto J, Miura K, Hirano Y, Watanabe K, Inada K, Hashimoto R

Journal of clinical psychopharmacology     2023年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Effects of Japanese policies and novel hypnotics on long-term prescriptions of hypnotics.

Takeshima M, Yoshizawa K, Enomoto M, Ogasawara M, Kudo M, Itoh Y, Ayabe N, Takaesu Y, Mishima K

Psychiatry and clinical neurosciences ( Psychiatry and Clinical Neurosciences )  77 ( 5 ) 264 - 272   2023年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIM: This study aimed to examine the effect of Japanese policies for appropriate hypnotics use and novel hypnotics (e.g., melatonin receptor agonist [MRA] and orexin receptor antagonist [ORA]) on long-term prescriptions of hypnotics. METHODS: This retrospective study was conducted using a large-scale health insurance claims database. Among subscribers prescribed hypnotics at least once between April 2005 and March 2021, those prescribed hypnotics for the first time after being included in the database in three periods (period 1, April 2012-March 2013; period 2, April 2016-March 2017; and period 3, April 2018-March 2019) were eligible. These were set considering the timing of the 2014 and 2018 medical fee revisions (2014 for polypharmacy of three or more hypnotics, 2018 for long-term prescription of benzodiazepine receptor agonists for >12 months). The duration of consecutive prescriptions of hypnotics over 12 months was evaluated. Factors associated with short-term prescriptions of hypnotics were also investigated. RESULTS: In total, 186,535 participants were newly prescribed hypnotics. The mean duration of prescriptions was 2.9 months, and 9.3% of participants were prescribed hypnotics for 12 months. Prescription periods were not associated with short-term prescriptions of hypnotics. ORA use was associated with short-term prescriptions of hypnotics (adjusted hazard ratio, 1.077; 95% confidence interval, 1.035-1.120; p<0.001), but MRA use was not. CONCLUSION: Japanese policies had no statistically significant effect on long-term prescriptions of hypnotics. Although this study suggests initiating ORA for insomniacs as a candidate strategy to prevent long-term prescriptions of hypnotics, further research is necessary to draw conclusions. This article is protected by copyright. All rights reserved.

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A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan.

Aoki Y, Takeshima M, Tsuboi T, Katsumoto E, Udagawa K, Inada K, Watanabe K, Mishima K, Takaesu Y

International journal of environmental research and public health ( International Journal of Environmental Research and Public Health )  20 ( 7 ) 5373 - 5373   2023年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Although long-term use of benzodiazepines and z-drugs (BZDs) is not recommended, little is known about the stakeholders’ perceptions. This study aimed to assess and compare the perceptions of BZD use and decision making regarding its discontinuation between psychiatric outpatients and psychiatrists. Methods: A cross-sectional survey was conducted. Results: Of 104 outpatients, 92% were taking hypnotics and 96% were taking anxiolytics for ≥a year, while 49% were willing to taper hypnotic/anxiolytics within a year of starting. Most psychiatrists felt that “patient and psychiatrist make the decision together on an equal basis” compared to patients (p &lt; 0.001), while more patients felt that “the decision is (was) made considering the psychiatrists’ opinion” compared to psychiatrists (p &lt; 0.001). Of 543 psychiatrists, 79% reported “patients were not willing to discontinue hypnotic/anxiolytic” whereas a certain number of patients conveyed “psychiatrists did not explain in enough detail about hypnotic/anxiolytic discontinuation such as procedure (18.3%), timing (19.2%), and appropriate condition (14.4%)”. Conclusion: The results suggest that the majority of psychiatric outpatients were taking hypnotic/anxiolytics for a long time against their will. There might be a difference in perceptions toward hypnotic/anxiolytic use and decision making for its discontinuation between psychiatric outpatients and psychiatrists. Further research is necessary to fill this gap.

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Effect of discontinuation of lemborexant following long-term treatment of insomnia disorder: Secondary analysis of a randomized clinical trial

Takaesu Y.

Clinical and Translational Science ( Clinical and Translational Science )  16 ( 4 ) 581 - 592   2023年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Satisfaction with web-based courses on clinical practice guidelines for psychiatrists: Findings from the "Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)" project.

Iida H, Okada T, Nemoto K, Hasegawa N, Numata S, Ogasawara K, Miura K, Matsumoto J, Hori H, Iga JI, Ichihashi K, Hashimoto N, Yamada H, Ohi K, Yasui-Furukori N, Fukumoto K, Tsuboi T, Usami M, Furihata R, Takaesu Y, Hishimoto A, Muraoka H, Katsumoto E, Nagasawa T, Ochi S, Komatsu H, Kikuchi S, Takeshima M, Onitsuka T, Tamai S, Kubota C, Inada K, Watanabe K, Kawasaki H, Hashimoto R

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  43 ( 1 ) 23 - 32   2023年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Management of unspecified anxiety disorder: Expert consensus.

Sakurai H, Inada K, Aoki Y, Takeshima M, Ie K, Kise M, Yoshida E, Tsuboi T, Yamada H, Hori H, Inada Y, Shimizu E, Mishima K, Watanabe K, Takaesu Y

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )    2023年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIMS: Treatment guidelines with respect to unspecified anxiety disorder have not been published. The aim of this study was to develop a consensus among field experts on the management of unspecified anxiety disorder. METHODS: Experts were asked to evaluate treatment choices based on eight clinical questions concerning unspecified anxiety disorder using a nine-point Likert scale (1 = "disagree" to 9 = "agree"). According to the responses from 119 experts, the choices were categorized into first-, second-, and third-line recommendations. RESULTS: Benzodiazepine anxiolytic use was not categorized as a first-line recommendation for the primary treatment of unspecified anxiety disorder, whereas multiple nonpharmacological treatment strategies, including coping strategies (7.9 ± 1.4), psychoeducation for anxiety (7.9 ± 1.4), lifestyle changes (7.8 ± 1.5), and relaxation techniques (7.4 ± 1.8), were categorized as first-line recommendations. Various treatment strategies were categorized as first-line recommendations when a benzodiazepine anxiolytic drug did not improve anxiety symptoms, that is, differential diagnosis (8.2 ± 1.4), psychoeducation for anxiety (8.0 ± 1.5), coping strategies (7.8 ± 1.5), lifestyle changes (7.8 ± 1.5), relaxation techniques (7.2 ± 1.9), and switching to selective serotonin reuptake inhibitors (SSRIs) (7.0 ± 1.8). These strategies were also highly endorsed when tapering the dosage of or discontinuing benzodiazepine anxiolytic drugs. There was no first-line recommendation regarding excusable reasons for continuing benzodiazepine anxiolytics. CONCLUSIONS: The field experts recommend that benzodiazepine anxiolytics should not be used as a first-line option for patients with unspecified anxiety disorder. Instead, several nonpharmacological interventions and switching to SSRIs were endorsed for the primary treatment of unspecified anxiety disorder and as alternatives to benzodiazepine anxiolytics.

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Effects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score-matched analysis.

Tsuboi T, Takaesu Y, Hasegawa N, Ochi S, Fukumoto K, Ohi K, Muraoka H, Okada T, Kodaka F, Igarashi S, Iida H, Kashiwagi H, Hori H, Ichihashi K, Ogasawara K, Hashimoto N, Iga JI, Nakamura T, Usami M, Nagasawa T, Kido M, Komatsu H, Yamagata H, Atake K, Furihata R, Kikuchi S, Horai T, Takeshima M, Hirano Y, Makinodan M, Matsumoto J, Miura K, Hishimoto A, Numata S, Yamada H, Yasui-Furukori N, Inada K, Watanabe K, Hashimoto R

Psychiatry and clinical neurosciences ( Psychiatry and Clinical Neurosciences )  77 ( 1 ) 30 - 37   2023年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Development and acceptability of a decision aid for anxiety disorder considering discontinuation of benzodiazepine anxiolytic.

Aoki Y, Takaesu Y, Inada K, Yamada H, Murao T, Kikuchi T, Takeshima M, Tani M, Mishima K, Otsubo T

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1083568   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Aim We aimed to develop a decision aid (DA) for individuals with anxiety disorders who consider tapering benzodiazepine (BZD) anxiolytics, and if tapering, tapering BZD anxiolytics with or without cognitive behavioral therapy (CBT) for anxiety. We also assessed its acceptability among stakeholders. Methods First, we conducted a literature review regarding anxiety disorders to determine treatment options. We cited the results of the systematic review and meta-analysis, which we conducted previously, to describe the related outcomes of two options: tapering BZD anxiolytics with CBT and tapering BZD anxiolytics without CBT. Second, we developed a DA prototype in accordance with the International Patient Decision Aid Standards. We carried out a mixed methods survey to assess the acceptability among stakeholders including those with anxiety disorders and healthcare providers. Results Our DA provided information such as explanation of anxiety disorders, options of tapering or not tapering BZD anxiolytics (if tapering, the options of tapering BZD anxiolytics with or without CBT) for anxiety disorder, benefits and risks of each option, and a worksheet for value clarification. For patients (n = 21), the DA appeared to be acceptable language (86%), adequate information (81%), and well-balanced presentation (86%). The developed DA was also acceptable for healthcare providers (n = 10). Conclusion We successfully created a DA for individuals with anxiety disorders who consider tapering BZD anxiolytics, which was acceptable for both patients and healthcare providers. Our DA was designed to assist patients and healthcare providers to involve decision-making about whether to taper BZD anxiolytics or not.

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Treatment strategy for insomnia disorder: Japanese expert consensus.

Takaesu Y, Sakurai H, Aoki Y, Takeshima M, Ie K, Matsui K, Utsumi T, Shimura A, Okajima I, Kotorii N, Yamashita H, Suzuki M, Kuriyama K, Shimizu E, Mishima K, Watanabe K, Inada K

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1168100   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Purpose: There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: 1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and 2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments. Methods: Experts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1=“disagree” to 9=“agree”). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations. Results: The primary pharmacological treatment, lemborexant (7.3±2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3±1.8) and suvorexant (6.8±1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4±1.1) and maintenance insomnia (8.1±1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6±2.3) and maintenance insomnia (5.7±2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5±1.8) and suvorexant (6.9±1.9) were categorized as first-line recommendations. Conclusion: Expert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.

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Physicians' attitudes toward hypnotics for insomnia: A questionnaire-based study.

Takeshima M, Aoki Y, Ie K, Katsumoto E, Tsuru E, Tsuboi T, Inada K, Kise M, Watanabe K, Mishima K, Takaesu Y

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1071962 - 1071962   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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INTRODUCTION: Benzodiazepines and non-benzodiazepines are still widely prescribed despite safety concerns and the introduction of novel hypnotics (orexin receptor antagonists [ORA] and melatonin receptor agonists [MRA]), which may be influenced by physicians' attitudes toward hypnotics. METHODS: A questionnaire survey was administered to 962 physicians between October 2021 and February 2022, investigating frequently prescribed hypnotics and the reasons for their selection. RESULTS: ORA were the most frequently prescribed at 84.3%, followed by non-benzodiazepines (75.4%), MRA (57.1%), and benzodiazepines (54.3%). Compared to non-frequent prescribers of hypnotics, a logistic regression analysis showed that frequent ORA prescribers were more concerned with efficacy (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.01-2.54, p = 0.044) and safety (OR: 4.52, 95% CI: 2.99-6.84, p < 0.001), frequent MRA prescribers were more concerned with safety (OR: 2.48, 95% CI: 1.77-3.46, p < 0.001), frequent non-benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91-6.04, p < 0.001), and frequent benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91-6.04, p < 0.001) but less concerned with safety (OR: 0.25, 95% CI: 0.16-0.39, p < 0.001). DISCUSSION: This study suggested that physicians believed ORA to be an effective and safe hypnotic and were compelled to prescribe benzodiazepine and non-benzodiazepine frequently, choosing efficacy over safety.

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Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation.

Futenma K, Takaesu Y, Komada Y, Shimura A, Okajima I, Matsui K, Tanioka K, Inoue Y

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1174719   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Comparison of the efficacy and safety of quetiapine and lithium for bipolar depression: A systematic review and meta-analysis of randomized controlled trials.

Ogasawara M, Takeshima M, Esaki Y, Kaneko Y, Utsumi T, Aoki Y, Watanabe N, Suzuki M, Takaesu Y

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 4 ) 410 - 420   2022年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Development of individual fitness score for conformity of prescriptions to the "Guidelines For Pharmacological Therapy of Schizophrenia".

Inada K, Fukumoto K, Hasegawa N, Yasuda Y, Yamada H, Hori H, Ichihashi K, Iida H, Ohi K, Muraoka H, Kodaka F, Ide K, Hashimoto N, Iga JI, Ogasawara K, Atake K, Takaesu Y, Nagasawa T, Komatsu H, Okada T, Furihata R, Kido M, Kikuchi S, Kubota C, Makinodan M, Ochi S, Takeshima M, Yamagata H, Matsumoto J, Miura K, Usami M, Kishimoto T, Onitsuka T, Katsumoto E, Hishimoto A, Numata S, Yasui-Furukori N, Watanabe K, Hashimoto R

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 4 ) 502 - 509   2022年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Decision aid development and its acceptability among adults with attention‐deficit/hyperactivity disorders regarding treatment discontinuation after remission

Noa Tsujii, Takashi Okada, Masahide Usami, Hidenori Kuwabara, Junichi Fujita, Hideki Negoro, Junzo Iida, Yumi Aoki, Yoshikazu Takaesu, Takuya Saito

Psychiatry and Clinical Neurosciences Reports ( Wiley )  1 ( 4 )   2022年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Attitudes and Difficulties Associated with Benzodiazepine Discontinuation.

Takeshima M, Aoki Y, Ie K, Katsumoto E, Tsuru E, Tsuboi T, Inada K, Kise M, Watanabe K, Mishima K, Takaesu Y

International journal of environmental research and public health ( International Journal of Environmental Research and Public Health )  19 ( 23 )   2022年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Long-term use of benzodiazepine receptor agonists (BZDs) may depend on clinicians' BZD discontinuation strategies. We aimed to explore differences in strategies and difficulties with BZD discontinuation between psychiatrists and non-psychiatrists and to identify factors related to difficulties with BZD discontinuation. Japanese physicians affiliated with the Japan Primary Care Association, All Japan Hospital Association, and Japanese Association of Neuro-Psychiatric Clinics were surveyed on the following items: age group, specialty (psychiatric or otherwise), preferred time to start BZD reduction after improvement in symptoms, methods used to discontinue, difficulties regarding BZD discontinuation, and reasons for the difficulties. We obtained 962 responses from physicians (390 from non-psychiatrists and 572 from psychiatrists), of which 94.0% reported difficulty discontinuing BZDs. Non-psychiatrists had more difficulty with BZD discontinuation strategies, while psychiatrists had more difficulty with symptom recurrence/relapse and withdrawal symptoms. Psychiatrists used more candidate strategies in BZD reduction than non-psychiatrists but initiated BZD discontinuation after symptom improvement. Logistic regression analysis showed that psychosocial therapy was associated with less difficulty in BZD discontinuation (odds ratio, 0.438; 95% confidence interval, 0.204-0.942; p = 0.035). Educating physicians about psychosocial therapy may alleviate physicians' difficulty in discontinuing BZDs and reduce long-term BZD prescriptions.

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Shared decision-making interventions for people with mental health conditions.

Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG

The Cochrane database of systematic reviews ( Wiley )  11 ( 11 ) CD007297   2022年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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「半年の休職で気分は良くなったけど, 朝決まった時間に起きられない」気分障害に併存する睡眠・覚醒相後退障害

高江洲義和

精神科治療学   37   263 - 266   2022年10月

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Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study.

Ochi S, Tagata H, Hasegawa N, Yasui-Furukori N, Iga JI, Kashiwagi H, Kodaka F, Komatsu H, Tsuboi T, Tokutani A, Numata S, Ichihashi K, Onitsuka T, Muraoka H, Iida H, Ohi K, Atake K, Kishimoto T, Hori H, Takaesu Y, Takeshima M, Usami M, Makinodan M, Hashimoto N, Fujimoto M, Furihata R, Nagasawa T, Yamada H, Matsumoto J, Miura K, Kido M, Hishimoto A, Ueno SI, Watanabe K, Inada K, Hashimoto R

The international journal of neuropsychopharmacology ( International Journal of Neuropsychopharmacology )  25 ( 10 ) 818 - 826   2022年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BACKGROUND: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Although antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. METHODS: We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. RESULTS: The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; p < 2.0 × 10 -16) and the ND-TRS without clozapine group (54.7%; p < 2.0 × 10 -16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; p = 1.1 × 10 -6) and the ND-TRS without clozapine group (17.0%; p = 5.9 × 10 -6). CONCLUSIONS: Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription.

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Efficacy and safety of adjunctive therapy to lamotrigine, lithium, or valproate monotherapy in bipolar depression: a systematic review and meta-analysis of randomized controlled trials.

Maruki T, Utsumi T, Takeshima M, Fujiwara Y, Matsui M, Aoki Y, Toda H, Watanabe N, Watanabe K, Takaesu Y

International journal of bipolar disorders ( International Journal of Bipolar Disorders )  10 ( 1 ) 24 - 24   2022年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BACKGROUND: The efficacy and safety of adjunctive therapy are unclear in bipolar depression. In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of second-generation antipsychotic, lamotrigine, lithium, or valproate therapy used in adjunction with lamotrigine, lithium, or valproate monotherapy in bipolar depression. A literature search of major electronic databases was conducted in February 2021, and all articles published until then were eligible. Two researchers independently screened relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. RESULTS: Five studies met the inclusion criteria. The meta-analysis revealed significant differences in the following outcomes: (i) remission rates from depressive episodes (risk ratio [RR]: 1.23, 95% confidence interval [CI] 1.01-1.50, p = 0.04), (ii) improvement in depressive symptoms (standardized mean difference [SMD]: 0.21, 95% CI 0.09-0.34, p = 0.001), (iii) improvement in quality of life (SMD: 0.22, 95% CI 0.06-0.37, p = 0.005), and (iv) rate of adverse events during the study period (RR: 1.12, 95% CI 1.03-1.22, p = 0.008). There was no significant difference between adjunctive therapy and monotherapy in the emergence of suicide-related behaviors, dropout rate during the study period, or rate of manic switching. CONCLUSIONS: Our results suggest that adjunctive second-generation antipsychotics, lamotrigine, lithium, or valproate increase both the benefits and risks in patients with bipolar depression, although there is no significant difference in severe adverse events. Adjunctive therapy should be provided through shared decision-making while considering the patients' condition in clinical settings.

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