Journal of Affective Disorders 53 (1999) 279–283 Preliminary communication Olanzapine in the treatment of adolescent acute mania: a report of seven cases a ,b , a a b * Cesar A. Soutullo , Michael T. Sorter , Keith D. Foster , Susan L. McElroy , a ,b Paul E. Keck a Division of Child and Adolescent Psychiatry, Children’ s Hospital Medical Center, Cincinnati, OH, USA b Department of Psychiatry, Biological Psychiatry Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA Received 9 December 1997; received in revised form 27 April 1998; accepted 5 June 1998 Abstract Background: Clozapine may be effective in adults and adolescents with treatment-resistant bipolar disorder. Olanzapine has a receptor affinity profile similar to that of clozapine. Methods: The responses of seven consecutive adolescents (ages 12–17) with DSM-IV bipolar disorder, manic episode, treated with olanzapine were evaluated. Response to olanzapine was rated as marked, moderate, minimal, none or worse. Results: Five (71%) adolescents showed a marked or moderate response. The mean6SD olanzapine dose was 0.14660.086 mg/kg/day (1166 mg/day). Conclusion: Olanzapine may have antimanic effects in some adolescents with acute mania. Controlled studies of olanzapine in adolescent bipolar disorder appear to be warranted.  1999 Elsevier Science B.V. All rights reserved. Keywords: Olanzapine; Bipolar disorder; Mania; Adolescent; Treatment-resistant; Atypical; Antipsychotic 1. Background Suppes et al., 1996; Frye et al., 1998), including adolescents (Kowatch et al., 1995; Fuchs, 1994). The Substantial clinical data suggest that the atypical new atypical antipsychotic olanzapine has a pharma- antipsychotic clozapine may be effective in the acute cological and receptor affinity profile similar to that and prophylactic treatment of some patients with of clozapine (binding potently to dopamine D , D , 1 2 treatment-resistant bipolar disorder (McElroy et al., D , histamine H , muscarinic M , serotonin 5-HT , 4 1 1 2C 1991; Zarate et al., 1995; Calabrese et al., 1996; 5-HT , 5-HT and a -noradrenergic receptors) 6 7 1 (Keck et al., 1997; Frye et al., 1998), but is devoid of clozapine’s more serious adverse effects (e.g., * Corresponding author. Biological Psychiatry Program, P.O. agranulocytosis). Olanzapine blocks 5-HT recep- 2A Box 670559, University of Cincinnati College of Medicine, 231 tors more potently than D receptors by a ratio of 3:1 Bethesda Avenue, Cincinnati, OH 45267-0559, USA. Tel.: 2 1 513-58-1132; Fax: 1 513-558-2882. (Keck et al., 1997). Preliminary data suggest that 0165-0327 / 99 / $ – see front matter  1999 Elsevier Science B.V. All rights reserved. PII: S0165-0327(98)00119-0