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 12-week single-blind trial of quetiapine for the treatment of mood symptoms in adolescents at high risk for developing bipolar I disorder.
OBJECTIVE To investigate the effectiveness and tolerability of quetiapine for the treatment of adolescents at high risk for developing bipolar I disorder . METHOD Twenty adolescents ( aged 12 - 18 years ) with mood symptoms that did not meet DSM-IV-TR criteria for bipolar I disorder and who had at least one first-degree relative with bipolar I disorder were recruited from August 2003 to June 2005 to participate in a single-blind , 12-week prospect i ve study of quetiapine .  Subjects were diagnosed using the Washington University in St. Louis Kiddie Schedule of Affective Disorders and Schizophrenia and were symptomatic , defined by a Young Mania Rating Scale ( YMRS ) score > or = 12 or a Childhood Depression Rating Scale-Revised Version ( CDRS-R ) score > or = 28 at baseline . The primary effectiveness measure was an endpoint Clinical Global Impressions-Improvement scale ( CGI-I ) score < or = 2 ( " much " or " very much " improved ) . Secondary efficacy measures included change from baseline to endpoint in YMRS and CDRS-R scores . RESULTS Mood disorder diagnoses in the adolescents consisted of bipolar disorder not otherwise specified ( N = 11 ) , dysthymia ( N = 3 ) , bipolar II disorder ( N = 3 ) , cyclothymia ( N = 2 ) , and major depressive disorder ( N = 1 ) . The majority of patients ( N = 12 , 60 % ) were non-responders to previous trials of psychotropic agents . Fifteen subjects ( 75 % ) completed all study visits . Eighty-seven percent of patients were responders ( CGI-I < or = 2 ) to quetiapine at week 12 ( mean + /- SD endpoint dose = 460 + /- 88 mg/day ) . YMRS scores decreased from 18.1 + /- 5.5 at baseline to 8.7 + /- 7.9 at endpoint ( p < .0001 ) , and CDRS-R scores decreased from 38.2 + /- 9.8 to 27.7 + /- 9.3 , ( p = .0003 ) . The most frequently reported adverse events were somnolence , headache , musculoskeletal pain , and dyspepsia . No subjects discontinued study participation due to adverse events . CONCLUSION Although these findings are limited by the small sample size and open-label treatment , the results suggest that quetiapine may be an effective treatment for mood symptoms in adolescents with a familial risk for developing bipolar I disorder
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 .