The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial

Abstract

Contrary to our hypotheses, bipolar disorder participants with a current comorbid substance use disorder were more likely to recover from psychosocial treatment for bipolar depression than patients without a current comorbid substance use disorder. If this finding is replicated, it has implications for the ordering of treatment for patients with comorbid bipolar disorder and substance use disorders.

Effects of psychotherapy on comorbid bipolar disorder and substance use disorder: A systematic review

“…The seven studies in this review included participants with a current SUD and examined the effects of a psychotherapy intervention. These included studies of:IPSRT 34,35 ; Step‐BD intensive psychotherapy (CBT, IPSRT, family focused therapy or collaborative care) 36 ; CBT 37 ; and integrated group therapy 38,39 40 …”

“…Although current SUD was not an exclusion criterion in the included studies, some studies did exclude SUD of greater severity. Two studies had no SUD exclusions based on severity 38‐40 while others excluded participants if they met the criteria for chronic substance abuse 34 ; immediate treatment was required 36 ; severe SUD was the principal diagnosis 35 ; there was continuous illicit substance misuse resulting in an unclear primary diagnosis 37 ; or participants were in residential treatment restricting substance use 38 …”

“…Baseline mean mood scores were in the range of severe depression and moderate mania 34 . The sub‐analysis by Gold et al 36 was based on participants having met criteria for a current major depressive episode at entry. Depressive severity was rated via the depression subscale (SUM‐D) of the Clinical Monitoring Form (CMF), 43 mean SUM‐D 2.91 ± 2.63.…”

“…The sub‐analysis from the STEP‐BD study 36 used the number of days from randomisation until recovery, with recovery defined as two or fewer mood symptoms for eight consecutive weeks, as the primary outcome. Two studies used time to recurrence, one using Research Diagnostic Criteria for a new affective episode, 34 and the other requiring DSM‐IV criteria fora mood episode 37 .…”

“…The STEP‐BD study used a nine‐month, 30 session intensive individual psychotherapy intervention (CBT, IPSRT, family focused therapy) compared with six sessions of collaborative care over three weeks 36 . Procedures to ensure treatment integrity were complicated due to the scale of the intervention 45 .…”