Summary of findings 4. Cytidine compared to placebo for adults with depression in bipolar disorder.
| Cytidine compared to placebo for adults with depression in bipolar disorder | ||||||
| Patient or population: adults (aged 18 years+) with depression in bipolar disorder Setting: any setting (outpatient, inpatient, or both) Intervention: cytidine Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with cytidine | |||||
| Efficacy: number of participants who respond to treatment ‐ at 3 months | Study population | OR 1.13 (0.30 to 4.24) | 35 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1,2 | ||
| 471 per 1000 | 501 per 1000 (211 to 790) | |||||
| Efficacy: number of participants who achieve remission | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Depression rating scale score | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Acceptability: total dropouts | Study population | OR 0.94 (0.12 to 7.52) | 35 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1,2 | ||
| 118 per 1000 | 111 per 1000 (16 to 501) | |||||
| Acceptability: dropouts due to adverse effects | ‐ | ‐ | ‐ | ‐ | ‐ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; HDRS: Hamilton depression rating scale; OR: Odds ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Downgraded by one point because no studies described the outcome assessment as masked. 2 Downgraded by two points because of the very small sample size and the wide confidence interval.