Intensive Therapy Plus Medications Works for Bipolar Depression

(April 2, 2007) -- Treating bipolar depression with intensive psychotherapy plus medication may be more effective than brief psychotherapy plus medication.

That news comes from a study of nearly 300 U.S. adults with bipolar disorder, which is marked by extreme mood shifts from depression to mania.

All of the patients were experiencing bipolar depression (the depressive phase of bipolar disorder) when the study started.

The patients who got intensive psychotherapy plus medication had their depression lift sooner and were more likely to maintain stable moods than those who got brief psychotherapy plus medication.

Intensive psychotherapy "should be considered a vital part of the effort to treat bipolar illness," says researcher David Miklowitz, PhD, in a news release.

Miklowitz and colleagues report their findings in the Archives of General Psychiatry.

Bipolar Depression Study

All patients took mood-stabilizing drugs such as lithium during the study. About 30% of patients were also taking antidepressants.

The researchers split the patients into two main groups:

One group got intensive psychotherapy (up to 30 psychotherapy sessions over nine months) in addition to medication. Those patients got one of the following three types of therapy:

• Family-focused therapy, which includes the patient and their relatives
• Cognitive behavior therapy, which teaches new coping strategies
• Interpersonal and social rhythm therapy, which includes solving relationship problems and setting healthy daily routines for sleep, exercise, and eating

Patients in the second group got brief psychotherapy (three sessions in six weeks) plus medication. The brief therapy sessions included a videotape and a workbook for patients to use.

Study's Results

The researchers followed the patients for one year.

On average, patients in the intensive-therapy group took nearly four months to have their depression ease, compared with nearly five months for those in the brief-therapy group.

By the end of the study, nearly two-thirds of the patients in the intensive-psychotherapy group (64%) had had at least two months of stable moods, compared with about half (51%) of those in the brief-therapy group.

Patients in the intensive-psychotherapy group were about 1.5 times more likely to have stable moods during any given month of the study than those who got brief psychotherapy.

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Antidepressants were not responsible for the difference between the two groups' outcomes, according to Miklowitz and colleagues.

The study doesn't show whether one type of intensive psychotherapy was more effective than the others. Future studies should look into that, note the researchers.

Source: Miklowitz, D. Archives of General Psychiatry, April 2007; vol 64: pp 419-427. News release, National Institute of Mental Health.

Last updated: 04/07

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