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 .
Open-Label, 8-Week Trial of Olanzapine and Risperidone for the Treatment of Bipolar Disorder in Preschool-Age Children
BACKGROUND To evaluate short-term safety and efficacy of atypical antipsychotics in a single-site , prospect i ve , open-label , 8-week study of risperidone and olanzapine monotherapy in preschoolers with bipolar disorder ( BPD ) . METHODS Risperidone was initiated at an open-label dose of .25 mg/day , increased weekly according to response and tolerability to a maximum does of 2.0 mg/day . Olanzapine was initiated at 1.25 mg/day and increased to no more than 10 mg/day . RESULTS Thirty-one children aged 4 - 6 years were treated with olanzapine ( n = 15 , 6.3 + /- 2.3 mg/day ) or risperidone ( n = 16 , 1.4 + /- .5 mg/day ) . At study end point ( week 8 or last observation carried forward ) , there was a 18.3 + /- 11.9 point ( t = -5.6 , p < .001 ) reduction in risperidone-treated subjects and a 12.1 + /- 10.4 point ( t = -4.4 , p < .001 ) reduction in Young Mania Rating Scale ( YMRS ) scores in olanzapine-treated subjects that did not differ between groups ( t = 1.4 , p = .2 ) . Response criteria ( Clinical Global Impression improvement of " Much " or " Very Much " improved or a YMRS change of > or= 30 % or more ) indicated no difference in rate of response with risperidone and olanzapine ( 69 % vs. 53 % , chi(2)((1 ) ) = .8 , p = .4 ) . CONCLUSIONS This prospect i ve open study suggests that treatment with risperidone or olanzapine may result in a rapid reduction of symptoms of mania  in preschool children with BPD . Because of substantial residual symptomatology and adverse effects , however , a pressing need exists to identify additional safe and effective treatments for the management of BPD in this high-risk 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 .