Atkin Tobias, Nuñez Nicolas, Gobbi Gabriella
Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, McGill University Health Center, Montreal, Quebec, Canada.
J Child Psychol Psychiatry. 2017 Aug;58(8):865-879. doi: 10.1111/jcpp.12735. Epub 2017 May 5.
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 systematically examine the impact of atypical antipsychotics (AAPs) and mood stabilisers in the treatment of bipolar depression and/or mixed states.
A literature search was conducted for studies assessing the efficacy of pharmacological treatments for bipolar disorder type I, type II and not otherwise specified with a recent depressive, mixed or manic episode (with depressive symptoms) following DSM-IV criteria in children and adolescents as either acute or maintenance treatment. The databases searched were PubMed/Medline, Google Scholar and Tripdatabase, as well as ClinicalTrials.gov. The search was limited to clinical trials, systematic reviews, meta-analyses and open-label trials published in the English language between the years 2000 and 2015. Sixty clinical studies were found assessing the efficacy of mood stabilisers and AAPs in paediatric BD. Fifteen studies were not included in the primary analysis because they did not assess depressive symptomology/include scores on rating scales of depressive symptoms (Online Supplementary Material).
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. Importantly, even though monotherapy with aripiprazole, risperidone, valproate and lithium was effective at controlling mania, these drugs were not effective at reducing depressive symptoms (level A evidence for nonrecommendation).
These results mostly overlap with the approved treatments for bipolar depression in adults.
双相情感障碍（BD）儿童和青少年的抑郁及混合症状管理仍存在争议。因此，本综述的目的是系统研究非典型抗精神病药物（AAPs）和心境稳定剂在双相抑郁和/或混合状态治疗中的作用。
检索评估按照《精神疾病诊断与统计手册》第四版标准，针对伴有近期抑郁、混合或躁狂发作（伴有抑郁症状）的儿童和青少年I型、II型及未特定类型双相情感障碍进行药物治疗作为急性或维持治疗疗效的研究。检索的数据库包括PubMed/Medline、谷歌学术和Tripdatabase以及ClinicalTrials.gov。检索限于2000年至2015年间以英文发表的临床试验、系统评价、荟萃分析和开放标签试验。共找到60项评估心境稳定剂和AAPs在儿童双相情感障碍中疗效的临床研究。15项研究未纳入主要分析，因为它们未评估抑郁症状学/未纳入抑郁症状评定量表得分（在线补充材料）。
有充分证据A级推荐使用奥氮平加氟西汀减轻双相抑郁中的抑郁症状，以及高剂量喹硫平治疗混合发作期间出现的抑郁症状。重要的是，尽管阿立哌唑、利培酮、丙戊酸盐和锂单药治疗在控制躁狂方面有效，但这些药物在减轻抑郁症状方面无效（不推荐的A级证据）。
这些结果大多与成人双相抑郁的获批治疗方法重叠。
