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 Prospective Open‐Label Trial of Lamotrigine Monotherapy in Children and Adolescents with Bipolar Disorder
Aim : To evaluate the safety and efficacy of lamotrigine monotherapy as an acute treatment of bipolar mood elevation in children with bipolar spectrum disorders . Method : This was a 12‐week , open‐label , prospect i ve trial of lamotrigine monotherapy to assess the effectiveness and tolerability of this compound in treating pediatric bipolar disorder . Assessment s included the Young Mania Rating Scale ( YMRS ) , Clinical Global Impressions‐Improvement scale ( CGI‐I ) , Children 's Depression Rating Scale ( CDRS ) , and Brief Psychiatric Rating Scale ( BPRS ) . Adverse events were assessed through spontaneous self‐reports , vital signs weight monitoring , and laboratory analysis . Results : Thirty‐nine children with bipolar disorder ( YMRS at entry : 31.6 ± 5.5 ) were enrolled in the study and 22 ( 56 % ) completed the 12‐week trial . Lamotrigine was slowly titrated to an average endpoint dose of 160.7 ± 128.3 in subjects < 12 years of age ( N = 22 ) and 219.1 ± 172.2 mg/day in children 12–17 years of age ( N = 17 ) . Treatment with lamotrigine was associated with statistically significant levels of improvement in mean YMRS scores ( −14.9 ± 9.7 , P < 0.001 ) at endpoint . Lamotrigine treatment also result ed in significant improvement in the severity of depressive , attention‐deficit/hyperactivity disorder ( ADHD ) , and psychotic symptoms  . Lamotrigine was generally well tolerated with marginal increase in body weight ( 47.0 ± 18.0 kg vs. 47.2 ± 17.9 kg , P= 0.6 ) and was not associated with abnormal changes in laboratory parameters . Several participants were discontinued due to skin rash ; in all cases , the rash resolved shortly after discontinuation of treatment . No patient developed Steven Johnson syndrome . Conclusions : Open‐label lamotrigine treatment appears to be beneficial in the treatment of bipolar disorder and associated conditions in children . Future placebo‐controlled , double‐blind studies are warranted to confirm these 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 .