Family Therapy With Medication Improves Depression In Bipolar Teens

In combination with medication, family-focused therapy appears to help
curb depression symptoms in teens with bipolar disorder, according to a
report released on September 1, 2008 in the Archives
of General Psychiatry, one of the JAMA/Archives
journals. 



Bipolar disorders are characterized by occasional periods of elevated
mood, known as mania. A large portion of patients who are diagnosed
with bipolar disorder present before age 18, according to the authors.
This can have especially negative effects, they say: "Early onset of
illness is associated with an unremitting
course of illness, frequent switches of polarity, mixed episodes,
psychosis, a high risk of suicide and poor functioning or quality of
life." They continue, saying: "The past decade has witnessed a
remarkable
increase in diagnoses of bipolar disorder in children and adolescents
and, correspondingly, drug trials for patients with early-onset
disorder. There has been comparatively little controlled examination of
psychotherapy for pediatric patients."



To investigate different therapies for young people with bipolar
disorders, David J. Miklowitz,
Ph.D., of the University of Colorado, Boulder, and colleagues conducted
a randomized controlled trial in 58 adolescent outpatients with
bipolar, with an average age of 14.5 years and a mood episode within
the three months preceding the study. The patients were assigned to one
of two groups: either pharacotherapy and family-focused treatment for
adolescents (30 subjects), or the control group administered
pharmacotherapy plus enhanced care. The former treatment was 21
50-minute sessions with the patient, parents, and siblings, relating
education about the disease, communication training, and
problem-solving skills development. The latter treatment had three
50-minute family sessions with a particular emphasis on relapse
prevention. Evaluators, blinded to the group of the patient, assessed
the teens every 3-6 months for two total years.



The follow-up was completed by 60% of the family-focused therapy group
and by 64.3% of the enhanced care group. No differences were found
between the two groups when examining rates or recovery or in elapsed
time before another episode, and a total 53 (91.4%) patients
experienced full recovery from the mood episode. Patients in the
famil-focused therapy group, however, recovered from depressive
symptoms, in particular, more quickly. They also spent less time in
depressive episodes in the evaluation period and generally had improved
depressive symptoms than the patients in enhanced care.



The authors conclude with comments on the implications of these
results: "To enhance full symptomatic and
functional recovery among adolescents, family-focused treatment for
adolescents may need to be supplemented with collaborative care
interventions found effective in mania stabilization," they say.
Continuing, an emphasis on "reducing conflict in family
relationships, enhancing social supports and teaching interpersonal
skills may underlie its stronger effects on bipolar depression."



Family-Focused Treatment for Adolescents With Bipolar
Disorder: Results of a 2-Year Randomized Trial

David
J. Miklowitz, PhD; David A. Axelson, MD; Boris Birmaher, MD; Elizabeth
L. George, PhD; Dawn O. Taylor, PhD; Christopher D. Schneck, MD; Carol
A. Beresford, MD; L. Miriam Dickinson, PhD; W. Edward Craighead, PhD;
David A. Brent, MD

Arch Gen Psychiatry. 2008;65(9):1053-1061.

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Written by Anna Sophia McKenney