Psychosocial Treatments for Bipolar Depression

Miklowitz, David J.; Otto, Michael W.; Frank, Ellen; Reilly-Harrington, Noreen A.; Wisniewski, Stephen R.; Kogan, Jane N.; Nierenberg, Andrew A.; Calabrese, Joseph R.; Marangell, Lauren B.; Gyulai, Laszlo; Araga, Mako; Gonzalez, Jodi M.; Shirley, Edwin; Thase, Michael E.; Sachs, Gary S.

doi:10.1001/archpsyc.64.4.419

Cited by 460 publications

(171 citation statements)

References 46 publications

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“…For acute bipolar depression in adults, an intensive FFT (up to 30 sessions; mean 14) out‐performed a three‐session control condition,94 although this study was limited by the caveats identified for CBT and IPSRT. Given that the original creation of FFT targeted factors related to depression, it may have specific antidepressant activity, which is also suggested by reduced depression relapse in maintenance studies.…”

Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…Family-focused therapy, interpersonal and social rhythm therapy and life goals program appear to be more effective when patients are acutely ill, whereas CBT and group psychoeducation showed better results when started during a period of remission [17]. CBT has been applied in many controlled studies of patients with BD [15,18,19,20,21,22,23,24]. When used in individuals as opposed to groups, CBT showed efficacy in the management of depressive episodes, reducing the time during which the patient was ill and the number of BD episodes, although all controlled trials have used different CBT models and criteria to select patients [25].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar Disorder

Gomes

Abreu

Brietzke

et al. 2011

Psychother Psychosom

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Background: This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy (CBGT) to prevent recurrence of episodes in euthymic patients with bipolar disorder. Methods: A randomized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission. An experimental CBGT manual was developed and added to treatment as usual (TAU), and results were compared with TAU alone. Results: Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse (Wilcoxon = 0.667; p = 0.414). When considering type of relapse, there was still no difference in either depressive (Wilcoxon = 3.328; p = 0.068) or manic episodes (Wilcoxon = 1.498; p = 0.221). Although occurrence of episodes also did not differ between groups (χ² = 0.28; p = 0.59), median time to relapse was longer for patients treated with CBGT compared to TAU (Mann-Whitney = –2.554; p = 0.011). Conclusions: Time to recurrence and number of episodes were not different in the group of patients treated with CBGT. However, median time to relapse was shorter in the TAU group. Studies with larger samples may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder. Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies. To our knowledge, this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder.

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“…If so, measurement of EE has the potential to be more than an indirect assessment of degree of family burden. Rather, it can help identify a constellation of attitudes and behaviors that can be addressed therapeutically with positive effects on patient adjustment (Miklowitz, et al, 2007).…”

Section: Central Relational Processesmentioning

confidence: 99%

“…However, there is growing evidence of the effectiveness of several specific approaches to family intervention. For example, the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years (see Miklowitz, 2007, for a review). Likewise, there is initial evidence that family-based interventions provided in the prodrome of a disorder may help alleviate its severity.…”

Section: Central Relational Processesmentioning

confidence: 99%