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 .
Divalproex sodium for pediatric mixed mania: a 6-month prospective trial.
OBJECTIVE This prospect i ve 6-month open trial examined the effectiveness and safety of divalproex sodium ( DVPX ) in pediatric mixed mania . METHOD Thirty-four subjects with a mean age of 12.3 ( SD = 3.7 ) years , DSM-IV diagnosis of a current mixed episode and a baseline Young Mania Rating Scale ( YMRS ) score > 20 were treated with DVPX monotherapy .  The primary outcome measures were the YMRS and the Child Depression Rating Scale-Revised . Secondary measures were the Clinical Global Impression Scale for Bipolar Disorder ( CGI-BP ) and the Children 's Global Assessment of Functioning Scale ( C-GAS ) . Measures of safety and tolerability were also administered . RESULTS Effect size ( Cohen 's d ) based on change scores from baseline was 2.9 for the YMRS and 1.23 for the CDRS-R. Response rate ( > or = 50 % change from baseline YMRS score and < or = 40 score on CDRS-R at the end of study ) was 73.5 % . The remission rate ( > or = 50 % change from baseline on YMRS , < or = 40 on CDRS-R , CGI-BP-Improvement subscale of < or = 2 , and > or = 51 CGAS score ) was 52.9 % . Significant improvements ( p < 0.001 ) from baseline were seen for mean scores on all outcome measures ( i.e. , YMRS , CGI-BP , CDRS-R , and C-GAS ) .  DVPX was safe and well tolerated with no serious adverse events during the 6-month trial . CONCLUSION This study provides evidence for the effectiveness and safety of DVPX in the treatment of pediatric mixed mania over a 6-month period . Placebo-controlled , r and omized trials involving larger sample s will ultimately shed light on the efficacy of this agent
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 .