1
|
Nunez NA, Singh B, Romo-Nava F, Joseph B, Veldic M, Cuellar-Barboza A, Cabello Arreola A, Vande Voort JL, Croarkin P, Moore KM, Biernacka J, McElroy SL, Frye MA. Efficacy and tolerability of adjunctive modafinil/armodafinil in bipolar depression: A meta-analysis of randomized controlled trials. Bipolar Disord 2020; 22:109-120. [PMID: 31643130 DOI: 10.1111/bdi.12859] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and safety of the dopaminergic-enhancing agent modafinil/armodafinil (MoArm) as adjunctive treatment for bipolar depression. METHODS A comprehensive search of major electronic databases was conducted to identify randomized controlled trials (RCTs) of adjunctive MoArm that included patients with bipolar I (BP-I) or bipolar II (BP-II) depression. Data for response/remission and all-cause discontinuation were analyzed. Effect size was summarized by relative risk (RR) using a random effect model. RESULTS Of 58 studies, five RCTs (N = 795 drug, N = 792 placebo) met inclusion criteria. Four armodafinil studies included only BP-I patients and one modafinil study included both bipolar subtypes with limited heterogeneity (I2 = 34%, P = .19; I2 = 18%, P = .30). Compared to placebo, augmentation with MoArm was associated with significantly greater rates of treatment response (RR, 1.18; 95% CI, 1.01-1.37; P = .03) and remission (RR, 1.38; 95% CI, 1.10-1.73; P = .005). All-cause discontinuation was not different than placebo (RR, 1.08; 95% CI, 0.89-1.30; P = .45) with no evidence of increased risk of mood switch or suicide attempts with MoArm (RR, 0.99; 95% CI, 0.39-2.5; P = .98; RR, 1.02; 95% CI, 0.37-2.85; P = .97). CONCLUSION This narrower scope meta-analysis of one drug for one disease suggests that adjunctive MoArm may represent a novel therapeutic intervention. Further studies delineating the subtypes of bipolar depression responsive to these novel dopaminergic-enhancing agents are encouraged.
Collapse
Affiliation(s)
- Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Balwinder Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Boney Joseph
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Alejandra Cabello Arreola
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Paul Croarkin
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Katherine M Moore
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Joanna Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Susan L McElroy
- Lindner Center of HOPE/University of Cincinnati, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
kahouei M, Alaei S, Shariat Panahi SSG, Zadeh JM. Strategy of health information seeking among physicians, medical residents, and students after introducing digital library and information technology in teaching hospitals of Iran. J Evid Based Med 2015; 8:91-7. [PMID: 25955257 DOI: 10.1111/jebm.12154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/25/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES It is important for physicians, medical students and health care organizations of developing countries to use reliable clinical information in order to deliver the best practice. Therefore, health sector of Iran endeavored to encourage physicians and medical students to integrate research findings into practice since 2005. Several educational interventions in the areas of information technology and databases were performed. Digital library was introduced in the teaching hospitals. The purpose of this study was to investigate whether these interventions increased the use of evidence-based health information resources among physicians, medical residents and students. METHODS This descriptive study involved 315 physicians, assistants and medical students in affiliated hospitals of Semnan University of medical sciences in 2013. RESULTS A total 52.9% of physicians and 79.5% of medical residents and students always used patient data. 81.3% of physicians and 67.1% of medical residents and students reported using their own experiences, 26.5% of physicians and 16.9% of medical residents and students always used databases such as PubMed and MEDLINE for patient care. CONCLUSION Our results revealed that in spite of providing educational and technical infrastructures for accomplishment of research utilization in medical education, the study subjects often identified and used what they regarded as reliable and relevant information from sources that do not truly represent the best evidence that is available.
Collapse
Affiliation(s)
- Mehdi kahouei
- Research Center for Social Determinants of Health, Health Information Management Department, Nursing and Allied Health Faculty, Semnan University of Medical Sciences, Semnan, Iran
| | - Safollah Alaei
- Surgery and Anesthesia Department, Nursing and Allied Health Faculty, Semnan University of Medical sciences, Semnan, Iran
| | | | | |
Collapse
|