Effectiveness of psychosocial treatments for bipolar disorder

The Archives of General Psychiatry has published a study on the effectiveness of psychosocial treatments for bipolar disorder, "Psychosocial Treatments for Bipolar Disorder."

This is a follow up study to one released last Thursday in the New England Journal of Medicine on the effects of antidepressants in the treatment of bipolar disorder. Both studies, called STEP-BD, were funded by the National Institute of Mental Health.

Bipolar disorder is a complex medical illness of the brain that affects 5.7 million Americans.

Ken Duckworth, M.D., medical director of the National Alliance on Mental Illness (NAMI) issued the following statement commenting on the studies:

"Researchers compared the two treatment models, one of which provided 'intensive psychotherapy,' which included weekly sessions in family focused therapy, or interpersonal and social rhythm therapy, or cognitive behavioral therapy; versus 'collaborative care,' which provided three brief psycho educational interventions over a six week period. They found study subjects receiving intensive psychotherapy were 1.58 times more likely be clinically well in a given month and had higher rates of recovery than individuals only receiving collaborative care. This is a call to action for access to these hard-to-find interventions.

The implications of this study are twofold. First, there needs to be more training programs that offer these psychosocial interventions so mental health providers can provide quality care. Second, the study also reminds us of the importance of family in treating people living with bipolar disorder. People who had relationships with family members, in both the control group and the experimental group, had better long-term results with the involvement of their family members.

This study concludes what NAMI members have known for years -- a combination of intensive psychosocial interventions and family involvement are both necessary ingredients for the best outcomes in bipolar disorder. Unfortunately many people who live with serious mental illnesses, like bipolar disorder, don't have access to the most basic care, much less the intensive psychosocial interventions recommended in the study.

The medication arm of the study, released last week in the New England Journal of Medicine, looked at two commonly prescribed antidepressants along with mood stabilizers for the symptoms of depression in individuals who have a diagnosis of bipolar disorder. The study found that the two antidepressants they studied did not work to relieve the depressive symptoms of the illness any better than placebo did for people with bipolar illness. The depressive phase of bipolar illness is notoriously difficult to treat, and more will have to be uncovered as to which pharmacologic strategies best complement the psychosocial treatments for this aspect of bipolar disorder. Most people with bipolar illness spend much more time in the depressive phase, so the need for more effective treatments is profound.