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 .
Double-blind randomized trial of risperidone versus divalproex in pediatric bipolar disorder.
OBJECTIVE To determine the relative effects of risperidone and divalproex in pediatric mania . METHODS This is a double-blind , r and omized , outpatient clinical trial with 66 children and adolescents ( mean age= 10.9 ± 3.3 years ; age range= 8 - 18 years ) with mania who were r and omly assigned to either risperidone ( 0.5 - 2 mg/day , n= 33 ) or divalproex ( 60 - 120 μg/mL , n= 33 ) for a six-week period . Measures included the Young Mania Rating Scale ( YMRS ) and Child Depression Rating Scale-Revised ( CDRS-R ) . RESULTS Mixed-effects regression models , with interaction between time and the active drug as predictors , found that the risperidone group had more rapid improvement than the divalproex group ( p < 0.05 ) , although final scores did not differ significantly between groups . Mixed models using only those subjects who completed the six-week study found similar results . The response rate on YMRS was 78.1 % for risperidone and 45.5 % for divalproex ( p < 0.01 ) . The remission rate for risperidone was 62.5 % , compared with 33.3 % for divalproex ( p < 0.05 ) . Improvement on the CDRS-R was significantly higher for the risperidone group relative to the divalproex group ( p < 0.05 ) . There were no significant differences between groups in safety , but subject retention was significantly higher at study endpoint in the risperidone group ( p < 0.01 ) . Dropout rate was 24 % in the risperidone group and 48 % in the divalproex group , with increased irritability being the most common reason for dropout in the latter . There was no significant weight gain in either group . CONCLUSION Results suggest that risperidone was associated with more rapid improvement and greater reduction in manic symptoms compared to divalproex . Although the results suggest that both drugs are safe , risperidone 's lower attrition rate and lower rate of adverse events may suggest better toleration . Clinical trials with larger sample s are required to confirm these preliminary findings
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 .