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Tamoxifen for bipolar disorder: Systematic review and meta-analysis
Jorge Palacios1, Ayşegül Yildiz2, Allan H Young1
11 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Journal of Psychopharmacology (Oxford, England)
|February 12, 2019
Summary
Tamoxifen shows promise for treating bipolar mania, reducing mania scale scores and increasing response rates compared to placebo. Further research is needed to explore its long-term effects and efficacy in treating bipolar depression.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Trials
Background:
- Tamoxifen, an oral medication, inhibits protein kinase C, similar to established bipolar disorder treatments like lithium and valproate.
- Bipolar disorder treatment remains a significant clinical challenge, necessitating novel therapeutic approaches.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating tamoxifen for bipolar disorder treatment.
- To assess the efficacy and acceptability of tamoxifen in managing acute manic episodes.
Main Methods:
- A comprehensive literature search was conducted across electronic databases and through expert consultation to identify relevant RCTs.
- Data extraction and meta-analysis were performed using R statistical software.
Main Results:
- Five placebo-controlled RCTs on tamoxifen for acute mania were identified; no trials addressed bipolar depression or relapse prevention.
- Tamoxifen demonstrated significant improvements in both change and endpoint mania scale scores compared to placebo (SMD -2.14 and 1.23, respectively).
- Response rates were significantly higher with tamoxifen (RR 4.35), and its acceptability was comparable to placebo (RR 1.03).
Conclusions:
- Tamoxifen emerges as a potentially effective treatment for acute manic episodes in bipolar disorder.
- Future research should explore tamoxifen's efficacy as an adjunct to dopamine antagonists and its long-term effects on mood, including depression and relapse prevention.
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