Eficácia, efetividade e segurança dos antipsicóticos no tratamento do transtorno afetivo bipolar: overview de revisões sistemáticas

Abstract

Mental disorders have gained increasing emphasis each year since the psychiatric reform, as individuals who often suffer from these disorders should be included in society in a fair and respectful manner. Many of these disorders are disabling, such as bipolar affective disorder (BPD), which affects many adults, with a prevalence of 1–3% of the global population. This disorder is characterized by mood swings caused by neurochemical changes, where the mood cycling can be fast or slow depending on pharmacotherapy and the severity of the bipolar affective disorder. In this sense, the symptoms of BPD can vary depending on the phase the individual is going through. Characteristics of mania include elevated mood, such as euphoria, while in hypomania, there is behavioral and mood dysregulation, with the patient having hyper-focus and greater energy for work, school, and sexual activities. Among other phases, depression leads to a decline in the central nervous system (CNS), which contributes to slow speech, daily activities, and mixed episodes, characterized by psychosis, dysphoria, accompanied by symptoms of the opposite polarity. The aim of this study was to evaluate the efficacy, effectiveness, and safety of BPD treatment, with the goal of comparing antipsychotics. To achieve this, search criteria were created based on the PICOS acronym, which were applied in various databases such as MEDLINE/PubMed, Scopus, and Scielo. The screening, eligibility, and data extraction steps were performed in duplicate in Excel® spreadsheets. A total of 668 studies were found. After screening titles and abstracts, 71 articles were included, of which 52 were selected for full reading, and 43 were eligible. To evaluate the quality of the studies, AMSTAR was used. After evaluating the results, it was noted that antipsychotics are more effective when combined with mood stabilizers. However, olanzapine and quetiapine were associated with a significant reduction in manic and depressive symptoms, while aripiprazole proved effective in preventing relapses, though it has a profile of adverse drug reactions, which compromises safety. When antipsychotics are combined with SSRIs, they show great cyclothymic potential. Moreover, quetiapine was the only antipsychotic in monotherapy with potential for symptomatic reduction in both manic and depressive phases. Asenapine showed a higher effectiveness profile with lower dropout rates due to adverse events.