Moreover, in studies of patients too young to be included in the aforestated placebo-controlled trials, olanzapine and risperidone were found to be effective in children as young as 4 years of age.98,99 Open-label treatment with carbamazepine has also been reported to provide amelioration of manic symptoms in youths with bipolar disorder.100 When examining the treatment of youths with bipolar disorder presenting with depression, open-label trials have

noted that lithium monotherapy,101 Inhibitors,research,lifescience,medical lamotrigine monotherapy, and lamotrigine adjunctive treatment102 may be effective in alleviating mood symptoms. Finally, treatment with open-label clozapine has described as being effective in youths who were treatment-resistant.103,104 Although ziprasidone, carbamazepine, lithium, lamotrigine, and clozapine have shown

positive effects in open-label trials, randomized placebo-controlled Inhibitors,research,lifescience,medical trials are needed to produce more definitive conclusions. While some salutary effects have been found in drug monotherapy studies, it appears that most children and adolescents Inhibitors,research,lifescience,medical do not experience Selleck MK518 complete symptom remission with thymoleptic monotherapy. Therefore, in an attempt to more completely address mood symptoms, combination pharmacotherapy has been examined in several clinical trials. In fact, in open-label studies, combination psychotropic treatments appear to be more successful than monotherapy treatments in pediatric bipolar disorder. For example, after 6 weeks of treatment with lithium, DVPX sodium, or carbamazepine, only 38% to 53% of subjects experienced symptom recovery, with Inhibitors,research,lifescience,medical those patients in the carbamazepine group experiencing the least symptom recovery.100 However, a proportion of subjects who did not originally respond to lithium, DVPX sodium, or carbamazepine monotherapy responded to combination treatment with two of the abovementioned mood stabilizers and adjunctive stimulants, antipsychotic agents, Inhibitors,research,lifescience,medical or an antidepressant medication.105 In addition, DelBello et al106 found in a double-blind study that treatment with quetiapine plus valproate

was more effective than treatment with quetiapine monotherapy in youths with bipolar disorder. Furthermore, combination treatment with both risperidone and lithium or risperidone and DVPX was found to be effective and safe in the treatment of children and adolescents with bipolar I disorder over a 6-month period.107 Linifanib (ABT-869) Combination treatment with lithium and DVPX has been found to ameliorate mood symptoms in several studies.105,108,109 Finally, positive results were found with combination treatment with lithium plus cither risperidone or a neuroleptic.97,107 Recently, other treatment options have been explored in pediatric bipolarity. For instance, Wozniak et al110 found open-label treatment with omega-3 fatty acids to improve manic symptoms in youth with bipolar disorder.