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.
Written by Anna Sophia McKenney