Long-term therapy effective in bipolar depression.

Not an alternative to meds, but a supplement.
April 10, 2007

Psychotherapy for as long as nine months is significantly more effective than short-term treatment for alleviating depression associated with bipolar disease, new research suggests.

The drugs used to treat depression are of limited use in treating the repeating depressive episodes of bipolar illness, according to background information in the article, published last week in The Archives of General Psychiatry.

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, interpersonal and social rhythm therapy, or family therapy) consisting of up to 30 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, and all were also being treated with mood-stabilizing medicines.

Cognitive behavioral therapy focuses on challenging and controlling negative thoughts. In interpersonal and social rhythm therapy, patients concentrate on stabilizing daily routines and resolving interpersonal problems. Family therapy 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.

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.”

Recovery rates after one year were a combined average of 64 percent for the intensive therapy groups, but only 52 percent for those who had brief therapy. In any given month, the researchers calculated, a patient undergoing longer-term therapy was more than one and a half times as likely to be well as one who had short-term treatment. Family therapy was slightly more effective than interpersonal or cognitive behavioral therapy, but the differences among the types of intensive treatment were not statistically significant.

“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 authors, one of whom has received grant support and consulting fees from several pharmaceutical companies, found that the median time to recovery for the patients in long-term therapy was 169 days, compared with 279 days for those who received the brief treatment.

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.”

(c) 2007 New York Times

Source: The New York Times

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