Thursday, October 15, 2020

Psychotherapy Combined With Medication May Prevent Recurrence in Patients With Bipolar Disorder

When combined with pharmacotherapy, manualized psychosocial interventions were associated with a lower risk of illness recurrence in patients with bipolar disorder compared with pharmacotherapy alone, a meta-analysis in JAMA Psychiatry found.

“There is increasing recognition that pharmacotherapy alone cannot prevent recurrences of bipolar disorder or fully alleviate post-episode symptoms or functional impairment,” wrote David J. Miklowitz, Ph.D., of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues.

Miklowitz and colleagues identified 39 randomized clinical trials involving 3,863 participants aged 12 years or older with bipolar disorder in which psychotherapy combined with pharmacotherapy was compared with treatment as usual (defined as pharmacotherapy with routine monitoring visits). The primary outcome was episode recurrence of any type—depressed, manic, or mixed—among participants in the first 12 months after the trial began.

“In our analysis, family therapy [cognitive-behavioral therapy], and group psychoeducation—all modalities that include patients as active participants—were associated with significantly improved outcomes compared with [treatment as usual] with regard to recurrence prevention and depression stabilization,” the authors wrote.

Additionally, the authors found that psychoeducation interventions with guided practices of illness management skills in a family or group format were associated with reduced illness recurrences compared with the same strategies in an individual format. Cognitive-behavioral therapy, family or group therapy, and interpersonal therapy were associated with stabilizing depressive symptoms compared with treatment as usual. 

“What do our findings suggest about treating outpatients with bipolar disorder? When the goals center on prevention of recurrences, patients should be engaged in family or group psychoeducation with guided skills training and active tasks to enhance coping skills (e.g., monitoring and managing prodromal symptoms) rather than being passive recipients of didactic education,” they wrote.

“Miklowitz and colleagues’ contribution may further serve as a call to action to enhance availability and uptake of these treatments in the community,” wrote Tina R. Goldstein, Ph.D., and Danella M. Hafeman, M.D., Ph.D., of the University of Pittsburgh School of Medicine in an accompanying editorial. “Unfortunately, data suggest substantially lower rates of psychotherapy receipt (26%-50%) compared with medication management (46%-90%) among adults with [bipolar disorder].”

For related information, see the Psychiatric News article “Antipsychotics Increasingly Prescribed for Bipolar Disorder.”

(Image: iStock/Chinnapong)


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