Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysis
Background Despite the widespread use of psychotropic medications in people with autism spectrum disorder (ASD), there is limited evidence to suggest that psychotropic medications including mood stabilisers are effective in individuals with ASD. Aims To carry out a systematic review and meta-analy...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-03-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472422000187/type/journal_article |
| _version_ | 1811156898124136448 |
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| author | Bharati Limbu Shoumitro Deb Meera Roy Rachel Lee Ashok Roy Oluwafemi Taiwo |
| author_facet | Bharati Limbu Shoumitro Deb Meera Roy Rachel Lee Ashok Roy Oluwafemi Taiwo |
| author_sort | Bharati Limbu |
| collection | DOAJ |
| description |
Background
Despite the widespread use of psychotropic medications in people with autism spectrum disorder (ASD), there is limited evidence to suggest that psychotropic medications including mood stabilisers are effective in individuals with ASD.
Aims
To carry out a systematic review and meta-analysis of randomised controlled trials (RCTs) that assessed the effectiveness of mood stabilisers in people with ASD.
Method
We searched the following databases: Cochrane Library, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, DARE, and ClinicalTrials.gov. In addition, we hand-searched 12 relevant journals. We used the Cochrane Risk of Bias and Jadad scores to assess the quality of included RCTs. We carried out a meta-analysis using a random-effects model.
Results
We included eight RCTs (four on valproate, two on levetiracetam, and one each on lamotrigine and topiramate) that included a total of 310 people with ASD, primarily children. Outcomes were based on core and associated ASD symptoms including irritability and aggression but not bipolar disorder. Only two small studies (25%) from the same group showed definite superiority over placebo and one over psychoeducation alone. Meta-analysis of pooled data on the Aberrant Behaviour Checklist-irritability, Clinical Global Impression Scale-improvement, and Overt Aggression Scale (OAS)/OAS-modified did not show any significant inter-group difference. The rates of adverse effects did not show any significant inter-group difference.
Conclusions
Given the methodological flaws in the included studies and the contradictory findings, it is difficult to draw any definitive conclusion about the effectiveness of mood stabilisers to treat either ASD core symptoms or associated behaviours. Robust large-scale RCTs are needed in the future to address this issue.
PROSPERO registration: CRD42021255467 on 18 May 2021.
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| first_indexed | 2024-04-10T04:57:42Z |
| format | Article |
| id | doaj.art-19c0a053a6b845878d4adf5bb54fe761 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:57:42Z |
| publishDate | 2022-03-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-19c0a053a6b845878d4adf5bb54fe7612023-03-09T12:29:19ZengCambridge University PressBJPsych Open2056-47242022-03-01810.1192/bjo.2022.18Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysisBharati Limbu0Shoumitro Deb1https://orcid.org/0000-0002-1300-8103Meera Roy2Rachel Lee3Ashok Roy4https://orcid.org/0000-0002-8432-981XOluwafemi Taiwo5Research Assistant, Department of Brain Sciences, Faculty of Medicine, Imperial College London, UKVisiting Professor of Neuropsychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, UKHonorary Consultant Psychiatrist, Hereford and Worcestershire Health and Care Trust, UKSpecialty Registrar in Psychiatry of Intellectual Disabilities, Coventry and Warwickshire Partnership NHS Foundation Trust, UKHonorary Professorial Fellow, Warwick Medical School, University of Warwick, UKCore Trainee in Psychiatry, Coventry and Warwickshire Partnership NHS Foundation Trust, UK. Background Despite the widespread use of psychotropic medications in people with autism spectrum disorder (ASD), there is limited evidence to suggest that psychotropic medications including mood stabilisers are effective in individuals with ASD. Aims To carry out a systematic review and meta-analysis of randomised controlled trials (RCTs) that assessed the effectiveness of mood stabilisers in people with ASD. Method We searched the following databases: Cochrane Library, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, DARE, and ClinicalTrials.gov. In addition, we hand-searched 12 relevant journals. We used the Cochrane Risk of Bias and Jadad scores to assess the quality of included RCTs. We carried out a meta-analysis using a random-effects model. Results We included eight RCTs (four on valproate, two on levetiracetam, and one each on lamotrigine and topiramate) that included a total of 310 people with ASD, primarily children. Outcomes were based on core and associated ASD symptoms including irritability and aggression but not bipolar disorder. Only two small studies (25%) from the same group showed definite superiority over placebo and one over psychoeducation alone. Meta-analysis of pooled data on the Aberrant Behaviour Checklist-irritability, Clinical Global Impression Scale-improvement, and Overt Aggression Scale (OAS)/OAS-modified did not show any significant inter-group difference. The rates of adverse effects did not show any significant inter-group difference. Conclusions Given the methodological flaws in the included studies and the contradictory findings, it is difficult to draw any definitive conclusion about the effectiveness of mood stabilisers to treat either ASD core symptoms or associated behaviours. Robust large-scale RCTs are needed in the future to address this issue. PROSPERO registration: CRD42021255467 on 18 May 2021. https://www.cambridge.org/core/product/identifier/S2056472422000187/type/journal_articleAutism spectrum disordermood stabilisersanti-epilepticsRCTssystematic review |
| spellingShingle | Bharati Limbu Shoumitro Deb Meera Roy Rachel Lee Ashok Roy Oluwafemi Taiwo Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysis BJPsych Open Autism spectrum disorder mood stabilisers anti-epileptics RCTs systematic review |
| title | Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysis |
| title_full | Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysis |
| title_fullStr | Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysis |
| title_full_unstemmed | Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysis |
| title_short | Randomised controlled trials of mood stabilisers for people with autism spectrum disorder: systematic review and meta-analysis |
| title_sort | randomised controlled trials of mood stabilisers for people with autism spectrum disorder systematic review and meta analysis |
| topic | Autism spectrum disorder mood stabilisers anti-epileptics RCTs systematic review |
| url | https://www.cambridge.org/core/product/identifier/S2056472422000187/type/journal_article |
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