Intensive psychotherapy benefits bipolar patients
Patients treated with drugs for bipolar disorder benefit greatly from the addition of intensive psychotherapy, according to findings published in the Archives of General Psychiatry.
“Bipolar disorder is an extremely debilitating illness, in large part because of the difficulty in treating bipolar depressive disorders,” Dr. David J. Miklowitz, of the University of Colorado, Boulder, and colleagues write. Clinical trials support the effectiveness of adding psychotherapy to drug treatment for preventing the recurrence of depressive and manic episodes. However, the effectiveness of various strategies has been unclear.
To investigate, the researchers compared the time to recovery and the likelihood of remaining well for 12 months after four disorder-specific psychotherapies. The 293 outpatients with bipolar I or II disorder also received drug treatment.
About half of the patients were assigned to one of three types of intensive psychotherapy (family-focused treatment, cognitive behavioral therapy, or interpersonal and social rhythm therapy) and the other half were assigned to collaborative care, which was a brief psychoeducational intervention.
Intensive psychotherapy consisted of up to 30 sessions for 9 months, and collaborative care included 3 sessions over 6 weeks. About 66 percent of patients in all of the groups completed therapy.
More patients in the intensive psychotherapy group recovered compared with patients in the collaborative care group, Miklowitz and colleagues report. The recovery rate at 12 months for patients in the intensive psychotherapy group was 64.4 percent; in the collaborative care group, it was 51.5 percent.
The average time to recovery was 113 days for patients who received intensive psychotherapy and 146 days for those who received collaborative care, the authors add.
The odds of a patient being clinically well during any study month were 58 percent greater with intensive psychotherapy than with collaborative care. The investigators found no significant differences in the outcome of patients in the three intensive psychotherapy groups.
The researchers suggest that the cost-effectiveness of different models of psychotherapy for bipolar disorder should now be compared.
SOURCE: Archives of General Psychiatry, April 2007.
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