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Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated for\u00a0\u22653 studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010four studies (n\u00a0=\u00a03,767: BD\u00a0=\u00a01,979; HCs\u00a0=\u00a01,788) reported on oxidative stress markers malondialdehyde (MDA), thiobarbituric acid reactive substances (TBARS), and total nitrites; antioxidants glutathione (GSH), uric acid, and zinc; or antioxidantenhancing enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), and GSH\u2010transferase (GST). Compared with HCs, BD was associated with higher GST (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), CAT (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.02), nitrites (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001), TBARS (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001), MDA (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), uric acid (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001), and lower GSH (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.006), without differences in SOD, GPX, and zinc. Compared to HCs, levels were higher in BD\u2010mania for TBARS (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001) and uric acid (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001); in BD\u2010depression for TBARS (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.02); and BD\u2010euthymia for uric acid (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.03). Uric acid levels were higher in BD\u2010mania vs BD\u2010depression (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.002), but not vs BD euthymia. TBARS did not differ between BD\u2010mania and BD\u2010depression. Medication\u2010free BD\u2010mania patients had higher SOD (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.02) and lower GPX (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001) than HCs. After treatment, BD did not differ from HCs regarding SOD and GPX.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Beyond a single biomarker of oxidative stress, the combination of several parameters appears to be more informative for BD in general and taking into account illness polarity. BD is associated with an imbalance in oxidative stress with some phase\u2010specificity for uric acid and TBARS and possible treatment benefits for SOD and GPX. Future studies should take into account confounding factors that can modify oxidative stress status and simultaneously measure oxidative stress markers and antioxidants including different blood sources.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12980","type":"journal-article","created":{"date-parts":[[2020,8,12]],"date-time":"2020-08-12T02:38:06Z","timestamp":1597199886000},"page":"117-129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":111,"title":["Oxidative stress parameters and antioxidants in patients with bipolar disorder: Results from a meta\u2010analysis comparing patients, including stratification by polarity and euthymic status, with healthy controls"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1515-2413","authenticated-orcid":false,"given":"Sara","family":"Jim\u00e9nez\u2010Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"CTS\u2010549 Research Group Institute of 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