The most comprehensive review to date has identified the most effective bipolar disorder treatments across different age groups and mood phases.
It has been published in The BMJ .
Bipolar disorder affects approximately 39.5 million people worldwide, and less than half find an effective treatment.
It causes phases of depression and elevated mood called mania.
This study, which included 77 meta-analyses spanning 116 different treatments, included experts from the University of Southampton, Ottawa Hospital (Canada), University of Barcelona (Spain), University of Padua (Italy), and Université Paris Nanterre (France).
Co-author Professor Samuele Cortese , NIHR research professor at the University of Southampton, said: "Living reviews like this one are game changers when it comes to updating international treatment guidelines.
"Rather than taking weeks to search for the evidence, experts can consult the website in real time during meetings for the latest evidence.
"Identifying the most effective treatments has traditionally been a challenge, but now we have a definitive guide, based on a very large body of evidence, that shows exactly which interventions yield the best results across different age groups and demographics."
The team behind the research created an open-access web platform that clearly presents the impact, side effects, and strength of evidence for each treatment based on the review .
The site was co-designed with guideline makers, people with lived experience of bipolar disease, clinicians and family doctors, and will be continuously updated with the latest evidence.
"Research on bipolar disorder treatment moves so quickly that it's nearly impossible to keep up," says Dr. Marco Solmi, clinician investigator and psychiatrist at The Ottawa Hospital and professor and Director of Research for the University of Ottawa's Department of Mental Health.
"Now people with bipolar disorder and their clinicians can see all the latest evidence in one place to inform treatment decisions."
"We hope clinicians will be able to use the platform with their own patients to find the best balance between efficacy and side effects, according to each patient's needs," said Dr. Michele De Prisco, psychiatrist and researcher at the Hospital Clínic de Barcelona and the University of Barcelona.
"Using the platform and its integrated preference tool, clinician and patient can decide together which treatment to consider next."
"Medications for bipolar disorder come with varied side-effects," said Dr. Jess Fiedorowicz, Head and Chief of Mental Health at The Ottawa Hospital and professor at the University of Ottawa.
"A tool that incorporates patient preferences and promotes shared decision-making can help find treatments that are a better fit."
The review's results have been used to update the Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines for the management of bipolar disorder.
The team's previous reviews on autism and ADHD interventions have influenced clinical guidelines and practice.
Future projects include reviews of treatments for eating disorders, PTSD, obsessive compulsive disorder and sleep disorder, as well as psychedelic interventions.
"There are many unnecessary and repetitive meta-analyses done in mental health research," said Dr. Richard Delorme, Head of the Center of Excellence for Autism and Neurodevelopmental Disorders at Robert Debré Hospital. "Living reviews like this can provide a more efficient approach."
This was the first living umbrella review to include all treatment strategies assessed across any age group and phase of bipolar disorder from the largest and best meta-analyses available to date.
It can be adapted rapidly as new evidence emerges and serves as a foundation for continuously improving care, which is why it is called a "living review."
"Next we want to use this website in education for clinicians and see how it performs in real-world settings," said Dr. Corentin Gosling, associate professor at the Université Paris Nanterre.
"We're particularly interested in its impact on intervention effectiveness safety, tolerability, adherence, health-care utilization, and shared decision-making."
