Therapy Plus Medication is More Effective Than Medication Alone for Patients With Bipolar Disorder

In a review of 39 randomized clinical trials, researchers found that the combination of medication and psychoeducational therapy has greater efficacy in the prevention of recurrence of illness in people with bipolar disorder than treatment with medication alone.

The review, published in JAMA Psychiatry, assessed data from studies that included adult and adolescent patients who were receiving medication for bipolar disorder at the time of the study. Additionally, the patients were randomly assigned to either an active family, individual or group therapy, or "usual care," which meant that the patient was receiving both medication with routine monitoring and support from a psychiatrist.

In total, the studies reviewed by the researchers followed the patients over a period of approximately 1 year; measured rates of recurrence of bipolar disorder, depression, and mania symptoms; and included study attrition or dropout rates.

The results demonstrated that psychoeducation with guided practice of illness management skills in a family or group setting had greater efficacy in reducing recurrences of mania and depressive symptoms than the same strategies in an individual therapy setting. Also, patients who received family-oriented therapies had lower rates of dropout than other patients.

Additionally, cognitive behavioral therapy, family therapy, and interpersonal therapy were more effective at stabilizing symptoms of depression than other types of treatment, according to the study.

The study's lead author, David Miklowitz, PhD, a distinguished professor of psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles, explained in a press release that these results show the importance of a support system for those with bipolar disorder.

"Not everyone may agree with me, but I think the family environment is very important in terms of whether somebody stays well," he said in the press release. "There's nothing like having a person who knows how to recognize when you're getting ill and can say, 'you're starting to look depressed or you're starting to get ramped up.' That person can remind their loved one to take their medications or stay on a regular sleep-wake cycle or contact the psychiatrist for a medication evaluation."

Miklowitz noted that this can also be true for patients who may not have close relatives to attend family therapy, as these patients could still receive that type of support through the group therapy environment.

"If you're in group therapy, other members of that group may be able to help you recognize that you're experiencing symptoms," he said in the press release. "People tend to pair off. It's a little bit like the AA model of having a sponsor."

REFERENCE

Therapy plus medication better than medication alone in bipolar disorder. Los Angeles: University of California — Los Angeles Health Sciences; October 14, 2020. https://www.eurekalert.org/pub_releases/2020-10/uoc--tpm101420.php. Accessed October 15, 2020.