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Mania in Teens: How to Treat?

Olanzapine was better than placebo, but its rate of response was poor in this industry-sponsored study.

Adolescent mania is associated with poor prognosis (Journal Watch Psychiatry May 7 2007), and some anticonvulsants are not effective for treating bipolar disorder in teens (Journal Watch Psychiatry Jul 24 2006). To learn about the effectiveness of olanzapine, researchers in a double-blind, manufacturer-sponsored study at 24 sites randomized 161 teenagers (mean age, 15) with mixed or manic episodes to 3 weeks of olanzapine (mean dose, 8.9 mg/day) or placebo.

Mean duration of the current episode was 310 days for olanzapine recipients and 237 for placebo recipients (not a statistically significant difference). Seventy-nine percent of the olanzapine group completed the study, as did 65% of the placebo group, but significantly more placebo recipients dropped out due to lack of efficacy. The olanzapine group had significantly higher rates of response (45% vs. 18%) and remission (35% vs. 11%) than did the placebo group, with the difference emerging at the end of week 1. The olanzapine group had significantly higher lipid indices, higher prolactin levels, and greater weight gain (3.7 kg vs. 0.3 kg) than did the placebo group. Anticholinergics were used (for extrapyramidal symptoms) by 5% of olanzapine recipients and 0% of placebo recipients.

Comment: Although the response and remission rates with olanzapine were significantly better than with placebo, they were woefully poor — fewer than half responded, and only about one third remitted. Nevertheless, given the severity of adolescent mania, treatment is necessary. The potential benefits of olanzapine, however, must be weighed against the enormous associated weight gain (much higher than in similar studies of adults), the impaired lipid and prolactin values, and extrapyramidal symptoms.

— Barbara Geller, MD

Published in Journal Watch Psychiatry November 19, 2007

Citation(s):

Tohen M et al. Olanzapine versus placebo in the treatment of adolescents with bipolar mania. Am J Psychiatry 2007 Oct; 164:1547.

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