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 .
A double-blind, placebo-controlled pilot study of quetiapine for depressed adolescents with bipolar disorder.
OBJECTIVE To conduct a pilot study comparing the effects of quetiapine and placebo for the treatment of depressive episodes in adolescents with bipolar I disorder . METHOD Thirty-two adolescents ( ages 12 - 18 years ) with a depressive episode associated with bipolar I disorder were r and omized to eight weeks of double-blind treatment with  quetiapine , 300 - 600 mg/day , or placebo . This two-site study was conducted from March 2006 through August 2007 . The primary efficacy measure was change in Children 's Depression Rating Scale-Revised Version ( CDRS-R ) scores from baseline to endpoint . Secondary efficacy measures included change in CDRS-R scores over the eight-week study period ( PROC MIXED ) , changes from baseline to endpoint in Hamilton Anxiety Rating Scale ( HAM-A ) , Young Mania Rating Scale ( YMRS ) , and Clinical Global Impression-Bipolar Version Severity ( CGI-BP-S ) scores , as well as response and remission rates . Safety and tolerability were assessed weekly . RESULTS There was no statistically significant treatment group difference in change in CDRS-R scores from baseline to endpoint ( p = 0.89 , effect size = -0.05 , 95 % confidence interval : -0.77 - 0.68 ) , nor in the average rate of change over the eight weeks of the study ( p = 0.95 ) . Additionally , there were no statistically significant differences in response ( placebo = 67 % versus quetiapine = 71 % ) or remission ( placebo = 40 % versus quetiapine = 35 % ) rates , or change in HAM-A , YMRS , or CGI-BP-S scores ( all p > 0.7 ) between treatment groups . Dizziness was more commonly reported in the quetiapine ( 41 % ) than in the placebo ( 7 % ) group ( Fisher 's exact test , p = 0.04 ) . CONCLUSIONS The results suggest that quetiapine monotherapy is no more effective than placebo for the treatment of depression in adolescents with bipolar disorder . However , limitations of the study , including the high placebo response rate , may have contributed to our findings and should be considered in the design of future investigations of pharmacological interventions for this population
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 .