Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic Review
Clonidine, an alpha-2 adrenergic agonist, has been proposed as an antimanic agent that acts by reducing noradrenergic transmission. We conducted a systematic review to examine the efficacy and safety of clonidine for acute mania/hypomania. A comprehensive literature search was performed to identify...
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| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/13/4/547 |
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| author | Prakamya Singal Nicolas A. Nuñez Boney Joseph Leslie C. Hassett Ashok Seshadri Balwinder Singh |
| author_facet | Prakamya Singal Nicolas A. Nuñez Boney Joseph Leslie C. Hassett Ashok Seshadri Balwinder Singh |
| author_sort | Prakamya Singal |
| collection | DOAJ |
| description | Clonidine, an alpha-2 adrenergic agonist, has been proposed as an antimanic agent that acts by reducing noradrenergic transmission. We conducted a systematic review to examine the efficacy and safety of clonidine for acute mania/hypomania. A comprehensive literature search was performed to identify randomized controlled trials (RCT) and non-randomized studies investigating the efficacy and safety of monotherapy/adjuvant treatment with clonidine for acute mania/hypomania in patients with bipolar disorder (BD). Nine studies (<i>n</i> = 222) met our inclusion criteria, including five RCTs (<i>n</i> = 159) and four non-randomized studies (<i>n</i> = 63). Non-randomized studies showed clonidine to help reduce symptoms of mania. However, data from placebo controlled RCTs were inconsistent. One RCT showed adjuvant clonidine as superior to placebo, whereas another RCT reported that clonidine was not better than placebo. In individual RCTs, lithium and valproate offered better antimanic effects compared to clonidine. Studies reported hypotension, depression, and somnolence as common adverse effects. Significant differences in study design and sample size contributed to high heterogeneity. This systematic review suggests low-grade evidence for clonidine as an adjuvant treatment for acute mania with mood stabilizers and inconclusive efficacy as monotherapy, warranting further well-designed RCTs. |
| first_indexed | 2024-03-11T05:12:36Z |
| format | Article |
| id | doaj.art-ff4acaf0d1434b64b1ba21437bb5809e |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-11T05:12:36Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-ff4acaf0d1434b64b1ba21437bb5809e2023-11-17T18:31:45ZengMDPI AGBrain Sciences2076-34252023-03-0113454710.3390/brainsci13040547Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic ReviewPrakamya Singal0Nicolas A. Nuñez1Boney Joseph2Leslie C. Hassett3Ashok Seshadri4Balwinder Singh5Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, IndiaDepartment of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USADepartment of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USAMayo Clinic Libraries, Mayo Clinic, Rochester, MN 55905, USADepartment of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USADepartment of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USAClonidine, an alpha-2 adrenergic agonist, has been proposed as an antimanic agent that acts by reducing noradrenergic transmission. We conducted a systematic review to examine the efficacy and safety of clonidine for acute mania/hypomania. A comprehensive literature search was performed to identify randomized controlled trials (RCT) and non-randomized studies investigating the efficacy and safety of monotherapy/adjuvant treatment with clonidine for acute mania/hypomania in patients with bipolar disorder (BD). Nine studies (<i>n</i> = 222) met our inclusion criteria, including five RCTs (<i>n</i> = 159) and four non-randomized studies (<i>n</i> = 63). Non-randomized studies showed clonidine to help reduce symptoms of mania. However, data from placebo controlled RCTs were inconsistent. One RCT showed adjuvant clonidine as superior to placebo, whereas another RCT reported that clonidine was not better than placebo. In individual RCTs, lithium and valproate offered better antimanic effects compared to clonidine. Studies reported hypotension, depression, and somnolence as common adverse effects. Significant differences in study design and sample size contributed to high heterogeneity. This systematic review suggests low-grade evidence for clonidine as an adjuvant treatment for acute mania with mood stabilizers and inconclusive efficacy as monotherapy, warranting further well-designed RCTs.https://www.mdpi.com/2076-3425/13/4/547clonidinesystematic reviewacute maniabipolar disorder |
| spellingShingle | Prakamya Singal Nicolas A. Nuñez Boney Joseph Leslie C. Hassett Ashok Seshadri Balwinder Singh Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic Review Brain Sciences clonidine systematic review acute mania bipolar disorder |
| title | Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic Review |
| title_full | Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic Review |
| title_fullStr | Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic Review |
| title_full_unstemmed | Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic Review |
| title_short | Efficacy and Safety of Clonidine in the Treatment of Acute Mania in Bipolar Disorder: A Systematic Review |
| title_sort | efficacy and safety of clonidine in the treatment of acute mania in bipolar disorder a systematic review |
| topic | clonidine systematic review acute mania bipolar disorder |
| url | https://www.mdpi.com/2076-3425/13/4/547 |
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