Bipolar Study Finds Family and Therapy Helps

According to a study published in the April 2 issue of the Archives of General Psychiatry, "Psychosocial Treatments for Bipolar Disorder," patients with bipolar disorder show greater improvement when family involvement and intensive psychotherapy is provided.

Bipolar disease is a complex brain disorder that affects over five-million individuals. Bipolar disease is generally characterized by a combination of depression and manic episodes, and can include psychotic features such as paranoia. The degree of disability varies as some victims find their illness well-managed with treatment, while many patients experience treatment-resistant depression, uncontrolled mania and other difficulties.

This study is a follow up study to one published March 29 in the New England Journal of Medicine concerning the effectiveness of antidepressants in treating bipolar disorder. The National Institute of Mental Health (NIMH) funded both studies.

According to a statement released by National Alliance of Mental Illness (NAMI) Medical Director, Ken Duckworth M.D., 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."

Researchers compared two treatment models: 'intensive psychotherapy' given weekly and biweekly for up to 30 sessions in nine months and 'collaborative care' consisting of three sessions in six weeks.

Types of Treatment

Intensive treatment included family-focused therapy or interpersonal and social-rhythm therapy (IPSRT) or cognitive behavior therapy (CBT).

--Family-focused therapy provides education and understanding about bipolar disorder and encourages both patients and relatives to take an active role in the disease, including medication adherence and implementation of a relapse-prevention plan.

--IPSRT focuses on disruptions in social routines and sleep/wake cycles, how bipolar patients can anticipate and deal with these events, and interpersonal problem resolution.

--Cognitive behavior therapy largely focuses on restructuring negative thoughts, problem solving, and challenging beliefs that may be unrealistic or aggravate bipolar symptoms.

Collaborative care, the control group, patients received a psycho-educational videotape and workbook. This therapy covered awareness, management and treatment of bipolar disorder with a focus on: medication adherence, schedule management (e.g. daily mood charting), awareness of biased thinking related to mood states, improving relationships through communication skills, and developing a treatment contract geared toward preventing episodes.

Collaborative care sessions focused on review of these materials and developing a treatment contract.

Study Results

Researchers found study subjects receiving intensive psychotherapy, in any of the three categories, were 1.58 times more likely be clinically well in a given month, and had higher recovery rates than subjects in the collaborative care group. 172 of the 293 patients recovered from their depression by the end of the study year while the remaining 121 patients either did not recover or dropped out of the study. The recovery rate was 64.4% in the intensive therapy group and 51.5% in the control group.

"This is a call to action for access to these hard-to-find interventions," Dr. Duckworth states, and finds, "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."

Relationships with family members, in both the control group and the experimental group, had better long-term results when family members were involved.

Medication Study

The medication part of the study looked at the difference between patients receiving one of two commonly prescribed antidepressants:paroxetine (common trade name, Paxil) or bupropion (common trade name, Wellbutrin) and at least one mood stabilizer (e.g. Lithium, Depakote) and subjects who received mood stabilizers alone.

This study found that the two antidepressants studied did not relieve the depressive symptoms of bipolar disorder any better than placebo, nor did they increase manic states. However, limitations to the study are well noted as is the need for more research in the area of pharmacology in treating bipolar disease.

Currently, the Food and Drug Administration (FDA) has not approved any of the more than 25 standard antidepressants for the treatment of bipolar depression. However, they are commonly prescribed along with mood-stabilizing drugs in the treatment of the disease. Both clinical and anecdotal claims vary as to the effectiveness of antidepressants.

Difficulties in Bipolar Treatment

Over five-million individuals have bipolar disorder and most do not have access to basic care, much less the intensive psychosocial interventions recommended in the study.

"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," says Duckworth.

Source:
National Alliance on Mental Illness: (http://nami.org)
New England Journal of Medicine: (http://content.nejm.org/cgi/content/full/NEJMoa064135) March 29, 2007
Archives of General Psychiatry: (http://archpsyc.ama-assn.org/) April 02, 2007

Disclaimer: This information is designed for educational purposes only and is not intended to substitute informed medical advice.