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Letters to the Editor
August 2009

Family-Focused Treatment for Adolescents With Bipolar Disorder

Arch Gen Psychiatry. 2009;66(8):915-917. doi:10.1001/archgenpsychiatry.2009.98

In the September 2008 issue of the Archives, Miklowitz and colleagues1 present results of a 2-year randomized trial on family-focused treatment for adolescents with bipolar disorder (FFT-A). They conclude that FFT-A is effective in stabilizing bipolar depressive symptoms among adolescents.

Since this is the first published randomized psychotherapy trial in this population, the topic is of high importance and interest to colleagues from research and clinical practice. Unfortunately, however, the report lacks important information necessary to assess the actual efficacy of the intervention because Miklowitz and colleagues did not report the exact number of subjects per group who entered the study in a syndromally depressed state. On page 1057, they note that the rate of recovery from index-episode depressive symptoms was high in the FFT-A (30 of 30, 100%) and control (25 of 28, 89.3%) group but that the FFT-A group experienced more rapid recovery from initial depressive symptoms. However, these conclusions are misleading since, according to the sample description (page 1059), at least 21% of the total sample of 58 entered the study because of manic, not depressive, symptoms. Accordingly, recovery rates from initial depressive symptoms should correspond to the subgroups of patients who entered the study syndromally depressed and not to the total number of subjects per group. Furthermore, it cannot be ruled out that the different proportion of time spent without depressive symptoms during follow-up in the 2 samples (page 1058) was owing to a different proportion of patients who already entered the study without syndromal depression. Finally, Miklowitz and colleagues failed to report a significance test for the group difference in depression-free weeks for the subsample of patients entering the study in a syndromally depressed state (page 1058). Delineation of this information is important, particularly because of the overall small sample sizes in this study.

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