The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: A controlled functional MRI investigation

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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“…Coupled with the findings of other smaller studies, this suggests that MBCT may have a role to play in anxiety reduction in BD 75, 116…”

Section: Foundations Of Managementsupporting

confidence: 68%

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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“…Women with BSD also were less likely to stay in the program (58.3 %) than women with MDD (92.6 %). The lack of significant improvement among women with BSD contrasts with results from open trials that have found positive effects of MBCT on depression or anxiety symptoms in bipolar disorder (Weber et al 2010;Miklowitz et al 2009;Deckersbach et al 2012;Ives-Deliperi et al 2013;Williams et al 2008). Our findings are, however, consistent with the single randomized trial of adults with bipolar disorder that found no effects of MBCT compared to usual care on depression or hypomania symptoms over 12-months (Perich et al 2013).…”

Section: Discussioncontrasting

confidence: 66%

Mindfulness-Based Cognitive Therapy for Perinatal Women with Depression or Bipolar Spectrum Disorder

et al. 2015

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The perinatal period is a high-risk time for mood deterioration among women vulnerable to depression. This study examined feasibility, acceptability, and improvement associated with mindfulness-based cognitive therapy (MBCT) in perinatal women with major depressive disorder (MDD) or bipolar spectrum disorder (BSD). Following a diagnostic evaluation, 39 perinatal women with a lifetime history of MDD (n = 27) or BSD (n = 12) enrolled in an 8-week program of MBCT classes (2 h each) that incorporated meditation, yoga, and mood regulation strategies. Participants were pregnant (n = 12), planning pregnancy (n = 11), or up to 1-year postpartum (n = 16). Participants were self-referred and most had subthreshold mood symptoms. Assessments of depression, (hypo)mania, and anxiety were obtained by interview and self-report at baseline, post-treatment and at 1-and 6-month post-treatment. Women with a history of MDD were more likely to complete the classes than women with BSD. Of 32 women who completed the classes, 7 (21.9 %) had a major depressive episode during the 6-month posttreatment follow-up. On average, participants with MDD reported improvements in depression from pre-to post-treatment. Mood improvement was not observed in the BSD group. In the full sample, improvements in depression symptoms across time points were associated with increasing mindful tendency scores. This study was limited by its uncontrolled design, heterogeneous sample, and questionnairebased assessment of mindfulness skills. MBCT may be an important component of care for perinatal women with histories of major depression. Its applicability to perinatal women with BSD is unclear.

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“…67 Similarly, a study investigating MBCT in the treatment of bipolar disorder reported increased activity in the mPFC during a mindfulness task following treatment as well as correlations between signal changes in the mPFC and mindfulness, as measured by the Five Factor Mindfulness Questionnaire (FFMQ). 68 Further studies have identified reduced amygdala reactivity in response to emotionally valenced images in healthy controls following a mindful attention group 69 and during an emotional processing task among novice meditators. 70 Critically, a recent study among individuals with generalized anxiety disorder reported increased functional connectivity between the ventrolateral PFC (vlPFC) and amygdala with associated reductions in anxiety symptoms following an 8-week MBSR intervention.…”

Section: Prefrontal Modulation Of Limbic Structures and Mindfulnessmentioning

confidence: 99%

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence

Boyd

Lanius

McKinnon

2018

jpn

261

177

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The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: A controlled functional MRI investigation

Cited by 122 publications

References 26 publications

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

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

Mindfulness-Based Cognitive Therapy for Perinatal Women with Depression or Bipolar Spectrum Disorder

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence

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