Background: The effect of psychopharmacology on clinical features of ongoing bipolar disorder episodes and the course of illness are good, but sometimes not sufficient for achieving remission. During the last decade manualized adjunctive psychosocial interventions have been developed. This review focuses on randomized controlled trials studying the effect of psychotherapy adjunctive to pharmacotherapy on recovery from depressive or manic phases, relapse prevention and functional improvement.
Methods: A systematic search for randomised controlled psychotherapy trials (RCPT) in bipolar disorders in the databases Medline and PsychInfo was performed. The search was supplemented by search in reference lists of the papers found and in review papers published the last couple of years. .
Results: Thirty publications on RCPT in patients with bipolar disorders were found, the majority dealing with bipolar I disorder or a mixed group of bipolar I, II and NOS disorder patients. The findings indicate that psychotherapy adjunctive to pharmacotherapy may reduce depressive symptoms, to some degree shorten the depressive episodes, reduce the need for hospitalisation, improve functioning and prolong time to a new depressive episode. This effect seems to be more related to the effect of receiving better knowledge and understanding of the disease and improvement of the patient’s way of coping with depression and life stress.
The effect on manic episodes, length of hospitalisation and future new episodes is less convincing per se, but if the psychological interventions achieve better compliance with the psychopharmacological, in particular the time to new relapse may be prolong and the number of relapses reduced.
However, there are several methodological issues limiting the generalization of the findings, and data on long-term effects (more than six months) are few.
Conclusions: Psychotherapy added to drug treatment improves the course and outcome of bipolar disorders and thus should be part of the treatment plan of patients with bipolar disorders. So far, there is not enough evidence to consider one type of psychotherapy better than another. However, relative few studies and methodological issues stress that our conclusion still cannot be generalized to all groups of patients with bipolar disorders without caution.