Intensive therapy helps in battle against bipolar disorder

New results from the largest federally funded bipolar study ever conducted show that patients who receive psychotherapy in addition to medication get better faster from bipolar disorder's debilitating depression and stay better longer, according to a University of Colorado at Boulder researcher involved in the study.

Part of a $26.8 million effort, the study found that adding intensive psychotherapy to a bipolar patient's medication treatment made them one and a half times more likely to be clinically well during any month of the study year, compared with a group that didn't receive intensive therapy, according to CU-Boulder psychology Professor David Miklowitz, the principal author of the study.

"The take home message here is that psychotherapy is a vital part of the effort to stabilize episodes of depression in people suffering from bipolar disorder," Miklowitz said. "If you get regular intensive therapy, the outcome for depression is going to be better than if you just take medications and have a couple of case management sessions."

The results of the study were published today in the April edition of the journal Archives of General Psychiatry.

Medication is the first line of defense against the disease, also called manic depression. Bipolar disorder is inherited and caused by a biochemical imbalance in the brain. It affects an estimated 5.7 million Americans, many of whom develop the disorder in their teens or as young adults.

While psychotherapy is routinely used to treat bipolar disorder, its effectiveness up until now has been unclear, according to Miklowitz. The seven-year study involved 293 people suffering from bipolar depression who were already taking medication. The participants, who were treated in 15 sites across the country, were randomly assigned to one of three types of standardized, intensive, nine-month psychotherapies, or to a control group that received a brief psychotherapy program that involved three sessions of education about the disorder.

The three types of intensive therapies included a family-focused therapy that involves participants' family members and focuses on family coping, communication and problem-solving; cognitive behavioral therapy that focuses on helping the patient understand and cope with distortions in thinking and activity; and interpersonal and social rhythm therapy that focuses on stabilizing daily and nightly routines and solving key relationship problems.

After one year, 64 percent of those in the intensive psychotherapy groups had recovered from the episode of depression that brought them into treatment, compared with 52 percent in the control group. Patients in intensive psychotherapy also recovered an average of 110 days faster than those in the control group. None of the three therapies appeared to be significantly more effective than the others, although rates of recovery from depression were highest among those in family-focused therapy, Miklowitz said.

While fully controlling the ups and downs of bipolar disorder is not possible, doctors can delay patients' relapses into debilitating periods of depression and manic behavior. Relapses of the disorder can split up marriages, cause job loss and even lead to suicide, according to Miklowitz.

"You need drugs like lithium as a first-line offense against depression, but then the question becomes 'What if the person is not responding right away?' " Miklowitz said. "That's when therapy may be the missing ingredient. We're not saying you should get therapy instead of medication. It's therapy on top of medication."

Getting the treatments into the community will be a challenging task. "There also has to be a consciousness among clinicians that bipolar people benefit most from learning skills to cope with the disorder, rather than just generic counseling," he said. "Teaching patients and family members how to immediately recognize and get treatment for emerging symptoms is essential."

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