Eficácia e Segurança dos Antipsicóticos de Segunda Geração no Tratamento da Mania Aguda em Crianças e Adolescentes com Transtorno Bipolar

Abstract

Early-onset bipolar disorder (BD) is a complex psychiatric condition in which the management of acute mania represents a major clinical challenge. Second-generation antipsychotics (SGAs) have emerged as a core therapy, but their use requires careful consideration of the balance between efficacy and safety in the pediatric population. Objectives: This review aims primarily to assess the efficacy of SGAs in reducing acute manic symptoms in children and adolescents with BD. Secondary objectives include analyzing the safety profile and comparing SGAs with mood stabilizers (MSs) and placebo. Methods: A systematic review of the literature was conducted through PubMed searches for randomized controlled trials (RCTs), meta-analyses, and open-label extension studies published up to December 2023. Eligible studies evaluated the efficacy and/or safety of SGAs for acute mania in patients aged ≤18 years with a diagnosis of BD type I. Data were extracted and narratively synthesized. Results: Meta-analyses demonstrate the superiority of the SGA class over placebo and MSs in reducing manic symptoms. Individually, risperidone, olanzapine, aripiprazole, and quetiapine showed robust efficacy. However, this efficacy is counterbalanced by a concerning safety profile, particularly significant weight gain and a high risk of metabolic syndrome, which affects 32.8% of youths with overweight/obesity undergoing SGA treatment. Other common adverse effects include sedation and somnolence. Conclusion: SGAs are effective and represent the first-line therapy for acute mania in children and adolescents with BD. However, significant risks-especially metabolic-require a personalized clinical approach with strict monitoring and proactive management of adverse effects to optimize outcomes in this vulnerable population.