RESULTS There is sufficient evidence for a Grade A recommendation of the use of olanzapine plus fluoxetine at reducing depressive symptoms in bipolar depression and of quetiapine at high doses for depressive symptoms occurring during mixed episodes .
These results mostly overlap with the approved treatments for bipolar depression in adults
BACKGROUND The management of depressive and mixed symptoms in children and adolescents with bipolar disorder ( BD ) remains a matter of debate .
The goal of this review is , thus , to systematic ally examine the impact of atypical antipsychotics ( AAPs ) and mood stabilisers in the treatment of bipolar depression and /or mixed states .
Acute treatment of pediatric bipolar I disorder, manic or mixed episode, with aripiprazole: a randomized, double-blind, placebo-controlled study.
OBJECTIVES To determine the efficacy and safety of aripiprazole for the treatment of pediatric bipolar I disorder , manic or mixed episode , with or without psychotic features . METHOD Subjects were enrolled between March 2005 and February 2007 in a r and omized , multicenter , double-blind 4-week study of aripiprazole 10 mg/d , aripiprazole 30 mg/d , and placebo .  Subjects ( n = 296 ) were 10 to 17 years old with a DSM-IV diagnosis of bipolar I disorder with current manic or mixed episodes , with or without psychotic features , and a Young Mania Rating Scale ( YMRS ) score > or = 20 . The primary efficacy variable was change from baseline in the YMRS total score . RESULTS Both doses of aripiprazole were superior to placebo on the YMRS total score beginning at week 1 and continuing through week 4 . Aripiprazole 10 mg and 30 mg were more effective than placebo on global improvement , mania , and overall bipolar illness outcome measures . Response ( > or = 50 % reduction in YMRS total score ) at week 4 was achieved by 44.8 % , 63.6 % , and 26.1 % of subjects in the aripiprazole 10 mg , aripiprazole 30 mg , and placebo groups , respectively ( P < .01 both doses vs placebo ) . Both doses were generally well tolerated . The most common adverse events were extrapyramidal disorder and somnolence ; rates were higher for aripiprazole 30 mg compared with aripiprazole 10 mg . Average weight gain was not significantly different between the aripiprazole 10 mg ( + 0.82 kg ) or 30 mg ( + 1.08 kg ) groups compared with the placebo group ( + 0.56 kg ) ( P = .35 and P = .13 , respectively ) . CONCLUSIONS Aripiprazole in daily doses of 10 mg or 30 mg is an effective and generally well-tolerated acute treatment for pediatric subjects with bipolar I mania or mixed episodes . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00110461
RESULTS There is sufficient evidence for a Grade A recommendation of the use of olanzapine plus fluoxetine at reducing depressive symptoms in bipolar depression and of quetiapine at high doses for depressive symptoms occurring during mixed episodes .
These results mostly overlap with the approved treatments for bipolar depression in adults
BACKGROUND The management of depressive and mixed symptoms in children and adolescents with bipolar disorder ( BD ) remains a matter of debate .
The goal of this review is , thus , to systematic ally examine the impact of atypical antipsychotics ( AAPs ) and mood stabilisers in the treatment of bipolar depression and /or mixed states .