Psychotherapies offer options for treating bipolar disorder

By Laura Cowen, medwireNews Reporter

Interpersonal and social rhythm therapy (IPSRT) and specialist supportive care (SSC) appear to be equally effective in reducing the symptoms of bipolar disorder in adolescents and young adults with the condition, study findings indicate.

Both types of psychotherapy reduced depressive and manic symptoms and improved social functioning over the course of 6 to 18 months when used in conjunction with pharmacotherapy, report Maree Inder (University of Otago, Christchurch, New Zealand) and co-authors in Bipolar Disorders.

The researchers randomly assigned 100 patients aged 15 to 36 years with bipolar I disorder, bipolar II disorder or bipolar disorder not otherwise specified to receive up to 18 months of treatment with IPSRT (n=49) or SST (n=51) as an adjunct to psychopharmacological treatment. The majority (78%) had bipolar I disorder and were female (76%), with high levels of Axis I comorbidity.

The team explains that IPSRT “combines interpersonal psychotherapy with a focus on social rhythms or routines in a patient’s life” and is based on “the links between mood symptoms and the quality of interpersonal relationships and social roles and the importance of maintaining daily routines.”

Unlike IPSRT, SSC does not focus on a systematic exploration of interpersonal issues or sleep and activity patterns, but is patient-led and combines supportive psychotherapy with psychoeducation.

Contrary to the researchers’ hypothesis, IPSRT was not superior to SSC in improving depressive or manic symptoms, as assessed by the Longitudinal Interval Follow-up Evaluation, or social functioning, assessed using the Social Adjustment Scale. Both treatments were equally effective in producing significant improvements in each outcome from baseline to 6–18 months.

Furthermore, there was no impact of lifetime or current Axis I comorbidity or age at study entry on outcome, but patients with current comorbid substance use disorder (SUD) assigned to SSC had a greater improvement than those assigned to IPSRT, note the researchers.

They say that this could be because “the patient-directed supportive approach of SSC may have allowed patients with current SUD to focus on issues more relevant to their context rather than fitting in with the IPSRT framework.”

Inder and co-authors acknowledge that the lack of a control group or minimal psychotherapy group limits their ability to draw conclusions regarding the effectiveness of the two therapies tested, but say that their findings warrant further investigation.

“Identifying effective treatments that particularly address depressive symptoms is important in reducing the burden of bipolar disorder”, they conclude.

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