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long-term psychotherapy effective in bipolar depression

by  Karen Field

Intensive psychotherapy for nine months is significantly more effective
than brief treatment for alleviating depression associated
with bipolar disease, new research suggests.

While all patients in the trial continued to be treated with mood-stabilizing medicines, this study found that the median time to recovery from a depressive episode for the patients in long-term intensive psychotherapy was 169 days, compared with 279 days for those who received the brief treatment (with no significant difference among the types of intensive treatment). In addition, those patients receiving the intensive long-term psychotherapy were functioning better at the end of nine months, particulalry in the areas of relationships and life satisfaction.

Medication alone has proved to be of limited use in treating the repeating depressive episodes of bipolar illness, which make a major contribution to the debilitating nature of this illness. “This is a monumental study,” said Myrna M. Weissman, a professor of psychiatry at Columbia who was not involved in the work. “There are no pharmaceutical companies willing to pay for research in psychotherapy, so we don’t have many clinical trials.” But, she added: “Psychosocial treatment for bipolar illness is not an alternative to medication. It’s a supplement.”

The cost of long-term therapy is high, and insurance companies are reluctant to cover it. But according to Dr. Weissman, the cost of not covering it could be higher. “It isn’t just the cost of the therapy. It’s the long-term cost. Bipolar illness has devastating effects on families as well as on the patients themselves.”

Study Method: real patients in real treatment settings

The researchers studied 293 patients with bipolar disease at 15 medical centers nationwide. They randomly assigned one group of 163 people to one of three kinds of psychotherapy: cognitive behavioral therapy (which focuses on challenging and controlling negative thoughts); interpersonal and social rhythm therapy (in which patients concentrate on stabilizing daily routines and resolving interpersonal problems; or family therapy (which engages family members to help solve problems related to the illness, like failing to take medication properly, and to reduce the number of negative family interactions).For these three therapies the treatment consisted of up to thirty 50-minute sessions over nine months. A second group of 130 patients was assigned to “collaborative care,” three sessions over six weeks designed to offer a brief version of the most common psychological and behavioral strategies shown to be beneficial in bipolar illness.

The participants, whose average age was 40, were followed for one year. Therapists at each of the 15 medical centers received brief training in the therapies they administered. “The study included real-world patients experiencing the early phases of a depressive episode,” said David J. Miklowitz, the study’s lead author and a professor of psychology and psychiatry at the University of Colorado. “And the therapists who delivered the treatment were trained by experts in the field with low-intensity training, which is typical of what’s available in real-life practice.”

Bakalar, N. (2007). Long-term Therapy Effective in Bipolar Depression. The New York Times, 10.4.07.

Miklowitz, D. J. et al. (2007). Psychosocial Treatments for Bipolar Depression: 
a 1-year randomized trial from the systematic treatment enhancement program.  Archives of General Psychiatry 64:419-426

Miklowitz, D. J. et al. (2007). Intensive Psychosocial Intervention Enhances Functioning in Patients With Bipolar Depression: results from a 9-month randomized controlled trial.  American Journal of Psychiatry 164:1340-1347

Karen Field is a psychotherapist in private practice in Auckland and thanks Suzanne Johnson a psychotherapist in private practice in Wellington for brining this article to her attention.

Article posted 11 April 2008