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The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials

The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials
The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials

Objective: People with mood disorders have increased risk of comorbid medical diseases versus the general population. It is paramount to identify interventions to improve physical health in this population. Methods: Umbrella review of meta-analyses of randomised controlled trials (RCTs) on pharmacological/non-pharmacological interventions for physical health outcomes/intolerability-related discontinuation in mood disorders (any age). Results: Ninety-seven meta-analyses were included. Among youths, against placebo, in depression, antidepressants/antipsychotics had higher discontinuation rates; in bipolar depression, olanzapine+fluoxetine worsened total cholesterol (TC)/triglycerides/weight gain (WG) (large ES). In adults with bipolar disorder, olanzapine worsened HbA1c/TC/WG (moderate/large ES); asenapine increased fasting glucose (small ES); quetiapine/cariprazine/risperidone induced WG (small/moderate ES). In bipolar depression, lurasidone was metabolically neutral. In depression, psychological interventions improved physical health-related quality of life (PHQoL) (small ES), fasting glucose/HbA1c (medium/large ES); SSRIs improved fasting glucose/HbA1c, readmission for coronary disease, pain (small ES); quetiapine/aripiprazole/olanzapine induced WG (small to large ES). Exercise improved cardiorespiratory fitness (moderate ES). In the elderly, fluoxetine yielded more detrimental cardiovascular effects than sertraline/escitalopram (large ES); antidepressants were neutral on exercise tolerance and PHQoL. In mixed age groups, in bipolar disorder aripiprazole was metabolically neutral; in depression, SSRIs lowered blood pressure versus placebo and serotonin-noradrenaline reuptake inhibitors (small ES); brexpiprazole augmentation caused WG and was less tolerated (small ES); exercise improved PHQoL (moderate ES). Conclusions: Some interventions (psychological therapies, exercise and SSRIs) improve certain physical health outcomes in mood disorders, few are neutral, but various pharmacological interventions are associated with negative effects. Evidence from this umbrella review has limitations, should consider evidence from other disorders and should be integrated with recent evidence from individual RCTs, and observational evidence. Effective treatments with either beneficial or physically neutral profiles should be prioritized.

1359-4184
369-390
Croatto, Giovanni
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Vancampfort, Davy
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Miola, Alessandro
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Olivola, Miriam
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Fiedorowicz, Jess G.
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Firth, Joseph
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Alexinschi, Ovidiu
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Gaina, Marcel A.
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Makkai, Vladimir
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Soares, Fernanda Cunha
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Cavaliere, Leandro
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Vianello, Giorgia
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Stubbs, Brendon
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Fusar-poli, Paolo
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Carvalho, Andre F.
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Vieta, Eduard
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Cortese, Samuele
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Shin, Jae Il
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Correll, Christoph U.
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Solmi, Marco
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Croatto, Giovanni
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Vancampfort, Davy
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Miola, Alessandro
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Olivola, Miriam
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Fiedorowicz, Jess G.
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Firth, Joseph
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Alexinschi, Ovidiu
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Gaina, Marcel A.
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Makkai, Vladimir
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Soares, Fernanda Cunha
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Cavaliere, Leandro
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Vianello, Giorgia
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Stubbs, Brendon
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Fusar-poli, Paolo
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Carvalho, Andre F.
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Vieta, Eduard
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Cortese, Samuele
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Shin, Jae Il
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Correll, Christoph U.
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Solmi, Marco
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Croatto, Giovanni, Vancampfort, Davy, Miola, Alessandro, Olivola, Miriam, Fiedorowicz, Jess G., Firth, Joseph, Alexinschi, Ovidiu, Gaina, Marcel A., Makkai, Vladimir, Soares, Fernanda Cunha, Cavaliere, Leandro, Vianello, Giorgia, Stubbs, Brendon, Fusar-poli, Paolo, Carvalho, Andre F., Vieta, Eduard, Cortese, Samuele, Shin, Jae Il, Correll, Christoph U. and Solmi, Marco (2022) The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials. Molecular Psychiatry, 28 (1), 369-390. (doi:10.1038/s41380-022-01770-w).

Record type: Review

Abstract

Objective: People with mood disorders have increased risk of comorbid medical diseases versus the general population. It is paramount to identify interventions to improve physical health in this population. Methods: Umbrella review of meta-analyses of randomised controlled trials (RCTs) on pharmacological/non-pharmacological interventions for physical health outcomes/intolerability-related discontinuation in mood disorders (any age). Results: Ninety-seven meta-analyses were included. Among youths, against placebo, in depression, antidepressants/antipsychotics had higher discontinuation rates; in bipolar depression, olanzapine+fluoxetine worsened total cholesterol (TC)/triglycerides/weight gain (WG) (large ES). In adults with bipolar disorder, olanzapine worsened HbA1c/TC/WG (moderate/large ES); asenapine increased fasting glucose (small ES); quetiapine/cariprazine/risperidone induced WG (small/moderate ES). In bipolar depression, lurasidone was metabolically neutral. In depression, psychological interventions improved physical health-related quality of life (PHQoL) (small ES), fasting glucose/HbA1c (medium/large ES); SSRIs improved fasting glucose/HbA1c, readmission for coronary disease, pain (small ES); quetiapine/aripiprazole/olanzapine induced WG (small to large ES). Exercise improved cardiorespiratory fitness (moderate ES). In the elderly, fluoxetine yielded more detrimental cardiovascular effects than sertraline/escitalopram (large ES); antidepressants were neutral on exercise tolerance and PHQoL. In mixed age groups, in bipolar disorder aripiprazole was metabolically neutral; in depression, SSRIs lowered blood pressure versus placebo and serotonin-noradrenaline reuptake inhibitors (small ES); brexpiprazole augmentation caused WG and was less tolerated (small ES); exercise improved PHQoL (moderate ES). Conclusions: Some interventions (psychological therapies, exercise and SSRIs) improve certain physical health outcomes in mood disorders, few are neutral, but various pharmacological interventions are associated with negative effects. Evidence from this umbrella review has limitations, should consider evidence from other disorders and should be integrated with recent evidence from individual RCTs, and observational evidence. Effective treatments with either beneficial or physically neutral profiles should be prioritized.

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GC_Physical Health MD_Manuscript_MolPsy_02june22 - Accepted Manuscript
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Accepted/In Press date: 26 August 2022
e-pub ahead of print date: 22 September 2022
Additional Information: © 2022. The Author(s), under exclusive licence to Springer Nature Limited.

Identifiers

Local EPrints ID: 471085
URI: http://eprints.soton.ac.uk/id/eprint/471085
ISSN: 1359-4184
PURE UUID: cd525486-ca48-4f7c-888a-16e71064cc2b
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 25 Oct 2022 16:42
Last modified: 12 Jan 2023 02:45

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Contributors

Author: Giovanni Croatto
Author: Davy Vancampfort
Author: Alessandro Miola
Author: Miriam Olivola
Author: Jess G. Fiedorowicz
Author: Joseph Firth
Author: Ovidiu Alexinschi
Author: Marcel A. Gaina
Author: Vladimir Makkai
Author: Fernanda Cunha Soares
Author: Leandro Cavaliere
Author: Giorgia Vianello
Author: Brendon Stubbs
Author: Paolo Fusar-poli
Author: Andre F. Carvalho
Author: Eduard Vieta
Author: Samuele Cortese ORCID iD
Author: Jae Il Shin
Author: Christoph U. Correll
Author: Marco Solmi

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