Atypical Antipsychotics Show Promise for Bipolar Children

STOCKHOLM – Atypical antipsychotics appear to be a good choice for treating children with bipolar disorder, and they also show promise for treating psychotic symptoms in these patients, Joseph Biederman, M.D., reported in a poster session at the annual congress of the European College of Neuropsychopharmacology.

Although rare, childhood bipolar disorder is among the most severely disabling pediatric mental disorders. Because this disorder has been assumed to be extremely rare, no standard treatment options exist. “Children with bipolar disorder are frequently treated with many medications with unclear efficacy and inadequate safety data,” said Dr. Biederman of Harvard Medical School, Boston.

Dr. Biederman undertook an 8-week randomized open-label study of the efficacy of olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), and ziprasidone (Geodon) in children with bipolar disorder. The 103 patients were aged 6-17 years. At baseline, they were all markedly impaired according to the Young Mania Rating Scale (YMRS). By the study's end, the mean dosages were 7.5 mg/day for olanzapine, 250 mg/day for quetiapine, 1.4 mg/day for risperidone, and 56 mg/day for ziprasidone.

After 8 weeks, there were no statistically significant differences between the groups in response. At least 50% of the children in each group showed a marked response (either a Clinical Global Impression rating of much or very much improved or a 30% reduction in symptoms).

Half the children in both the olanzapine and ziprasidone groups experienced a robust response to the therapy (Clinical Global Impression rating of much or very much improved and a 30% reduction in YMRS scores). The rate of robust response was higher in the quetiapine (55%) and risperidone groups (75%).

Weight gain over the study was substantial but varied significantly across study groups. Olanzapine was associated with an increase (4.9 kg) that was significantly greater than the weight gain for risperidone (2.1 kg), quetiapine (1.9 kg), and ziprasidone (0.8 kg).

Some of these medications also appear effective in decreasing psychotic symptoms in pediatric bipolar patients, Dr. Biederman reported in a separate poster. In a similarly designed 8-week open-label trial, 110 children with bipolar disorder were randomized to risperidone, quetiapine, or olanzapine. The children were aged 6-17 years, and 26% had a history of psychosis.

By the trial's end, there was a significant reduction of 10 points on the Brief Psychiatric Rating Scale that did not differ between groups. Differences did emerge in changes measured by the YMRS. All the drugs were associated with significant improvements in symptoms of mania, but only risperidone was associated with a significant improvement in symptoms of psychosis.

Side effects were mild and included increased appetite (29%), gastrointestinal discomfort (20%), headache (18%), sedation (18%), and myalgia (10%). Weight gain was highest in the olanzapine group (mean 4.7 kg). Those in the risperidone group gained a mean of 1.97 kg, and those in the quetiapine group gained a mean of 1.4 kg.

There was a statistically significant increase in prolactin levels in subjects treated with risperidone (33.9 ng/mL) and olanzapine (5.1 ng/mL), but not quetiapine (0.5 ng/mL), Dr. Biederman said.

STOCKHOLM – Atypical antipsychotics appear to be a good choice for treating children with bipolar disorder, and they also show promise for treating psychotic symptoms in these patients, Joseph Biederman, M.D., reported in a poster session at the annual congress of the European College of Neuropsychopharmacology.

Although rare, childhood bipolar disorder is among the most severely disabling pediatric mental disorders. Because this disorder has been assumed to be extremely rare, no standard treatment options exist. “Children with bipolar disorder are frequently treated with many medications with unclear efficacy and inadequate safety data,” said Dr. Biederman of Harvard Medical School, Boston.

Dr. Biederman undertook an 8-week randomized open-label study of the efficacy of olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), and ziprasidone (Geodon) in children with bipolar disorder. The 103 patients were aged 6-17 years. At baseline, they were all markedly impaired according to the Young Mania Rating Scale (YMRS). By the study's end, the mean dosages were 7.5 mg/day for olanzapine, 250 mg/day for quetiapine, 1.4 mg/day for risperidone, and 56 mg/day for ziprasidone.

After 8 weeks, there were no statistically significant differences between the groups in response. At least 50% of the children in each group showed a marked response (either a Clinical Global Impression rating of much or very much improved or a 30% reduction in symptoms).

Half the children in both the olanzapine and ziprasidone groups experienced a robust response to the therapy (Clinical Global Impression rating of much or very much improved and a 30% reduction in YMRS scores). The rate of robust response was higher in the quetiapine (55%) and risperidone groups (75%).

Weight gain over the study was substantial but varied significantly across study groups. Olanzapine was associated with an increase (4.9 kg) that was significantly greater than the weight gain for risperidone (2.1 kg), quetiapine (1.9 kg), and ziprasidone (0.8 kg).

Some of these medications also appear effective in decreasing psychotic symptoms in pediatric bipolar patients, Dr. Biederman reported in a separate poster. In a similarly designed 8-week open-label trial, 110 children with bipolar disorder were randomized to risperidone, quetiapine, or olanzapine. The children were aged 6-17 years, and 26% had a history of psychosis.

By the trial's end, there was a significant reduction of 10 points on the Brief Psychiatric Rating Scale that did not differ between groups. Differences did emerge in changes measured by the YMRS. All the drugs were associated with significant improvements in symptoms of mania, but only risperidone was associated with a significant improvement in symptoms of psychosis.

Side effects were mild and included increased appetite (29%), gastrointestinal discomfort (20%), headache (18%), sedation (18%), and myalgia (10%). Weight gain was highest in the olanzapine group (mean 4.7 kg). Those in the risperidone group gained a mean of 1.97 kg, and those in the quetiapine group gained a mean of 1.4 kg.

There was a statistically significant increase in prolactin levels in subjects treated with risperidone (33.9 ng/mL) and olanzapine (5.1 ng/mL), but not quetiapine (0.5 ng/mL), Dr. Biederman said.

STOCKHOLM – Atypical antipsychotics appear to be a good choice for treating children with bipolar disorder, and they also show promise for treating psychotic symptoms in these patients, Joseph Biederman, M.D., reported in a poster session at the annual congress of the European College of Neuropsychopharmacology.

Although rare, childhood bipolar disorder is among the most severely disabling pediatric mental disorders. Because this disorder has been assumed to be extremely rare, no standard treatment options exist. “Children with bipolar disorder are frequently treated with many medications with unclear efficacy and inadequate safety data,” said Dr. Biederman of Harvard Medical School, Boston.

Dr. Biederman undertook an 8-week randomized open-label study of the efficacy of olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), and ziprasidone (Geodon) in children with bipolar disorder. The 103 patients were aged 6-17 years. At baseline, they were all markedly impaired according to the Young Mania Rating Scale (YMRS). By the study's end, the mean dosages were 7.5 mg/day for olanzapine, 250 mg/day for quetiapine, 1.4 mg/day for risperidone, and 56 mg/day for ziprasidone.

After 8 weeks, there were no statistically significant differences between the groups in response. At least 50% of the children in each group showed a marked response (either a Clinical Global Impression rating of much or very much improved or a 30% reduction in symptoms).

Half the children in both the olanzapine and ziprasidone groups experienced a robust response to the therapy (Clinical Global Impression rating of much or very much improved and a 30% reduction in YMRS scores). The rate of robust response was higher in the quetiapine (55%) and risperidone groups (75%).

Weight gain over the study was substantial but varied significantly across study groups. Olanzapine was associated with an increase (4.9 kg) that was significantly greater than the weight gain for risperidone (2.1 kg), quetiapine (1.9 kg), and ziprasidone (0.8 kg).

Some of these medications also appear effective in decreasing psychotic symptoms in pediatric bipolar patients, Dr. Biederman reported in a separate poster. In a similarly designed 8-week open-label trial, 110 children with bipolar disorder were randomized to risperidone, quetiapine, or olanzapine. The children were aged 6-17 years, and 26% had a history of psychosis.

By the trial's end, there was a significant reduction of 10 points on the Brief Psychiatric Rating Scale that did not differ between groups. Differences did emerge in changes measured by the YMRS. All the drugs were associated with significant improvements in symptoms of mania, but only risperidone was associated with a significant improvement in symptoms of psychosis.

Side effects were mild and included increased appetite (29%), gastrointestinal discomfort (20%), headache (18%), sedation (18%), and myalgia (10%). Weight gain was highest in the olanzapine group (mean 4.7 kg). Those in the risperidone group gained a mean of 1.97 kg, and those in the quetiapine group gained a mean of 1.4 kg.

There was a statistically significant increase in prolactin levels in subjects treated with risperidone (33.9 ng/mL) and olanzapine (5.1 ng/mL), but not quetiapine (0.5 ng/mL), Dr. Biederman said.