Published Comparison Studies of Efficacy of Mood Stabilizers and Atypical Antipsychotics With Pediatric Bipolar Disorder

Lithium, Divalproex, CarbamazepineKowatch et al (2000)746–18; n = 42Open-label trialLarge effect size for all 3 medications; response rate with manic symptoms of divalproex 53%, lithium 38%, and carbamazepine 38%Manic or mixed
Quetiapine, DivalproexDel Bello et al (2002)7512–18; n = 30Double-blindSignificant response rate difference, 87% vs 53% of placebo groupManic or mixed; divalproex plus quetiapine versus divalproex plus placebo
Risperidone, Lithium, DivalproexPavuluri et al (2004)765–18; n = 37Open-label trialResponse rate 80% for risperidone plus divalproex and 82% for risperidone plus lithiumManic or mixed
Lithium, DivalproexFindling et al (2005)775–17; n = 60Double-blind; no placebo groupNo significant difference between the groupsStabilized on lithium plus divalproex and then compared maintenance monotherapy with one or the other
Quetiapine, DivalproexDel Bello et al (2006)7812–18; n = 50Double-blind, no placebo groupSignificant improvement in both groups; no significant difference in amount of improvement but significantly faster improvement in quetiapine groupManic or mixed; compared quetiapine and divalproex
Risperidone, DivalproexMacMillan et al (2008)795–14; n = 28Records reviewRisperidone group showed significantly faster decrease of symptoms than divalproex groupMore wt gain with risperidone
Risperidone, DivalproexPavuluri et al (2010)808–18; n = 66Double-blind, no placebo groupMore rapid improvement in risperidone group but no difference in final scoresNo significant wt gain in either group; better retention of subjects in risperidone group