Pharmacotherapy: Lithium, a mood stabilizing medicationMedication is typically the first line of defense in treating bipolar disorder, and one of the most widely used medications is the mood stabilizer Lithium (Malhi, Gessler & Outhred, 2017). The reason Lithium is so popular is that it works so strongly at treating mania and hypomania. Malhi, Gessler & Outhred (2017) reviewed international clinical practice guidelines for the use of Lithium for treating bipolar. They reviewed 13 guidelines that met their criteria and of those 13, seven recommend Lithium as the “first line monotherapy” for the treatment of mania and another five recommend it as the monotherapy for “less acute” mania (Malhi, Gessler & Outhred, 2017). For those experiencing psychosis, Lithium is often given in conjunction with a benzodiazepine or an antipsychotic. While the other medication is used short-term and then tapered off, Lithium is typically used long-term to help maintain stability (Malhi, Gessler & Outhred, 2017).
Cognitive analytic therapy for bipolar disorder: A pilot randomized controlled trial.One study by Evans, Kellett, Heyland, Hall, and Majid (2016), investigated the effectiveness of cognitive analytic therapy (CAT) on bipolar symptoms. The patients in this study were in remission at the time of the trial. The participants were randomly assigned to different treatment groups.
One group received twenty four sessions of CAT and the other group continued their normal therapy routines. CAT therapy sessions include three distinct phases of therapy. The first phase includes helping the patient understand the possible origins and maintenance of current difficulties. The second phase includes self-monitoring by the patient which allows them to become more aware of their own moods and behaviors. The final phase includes the patient and psychotherapist designing new ways of thinking and behavior to allow the patient to change their patterns. Out of the nine participants, only two were considered recovered at the end of the study. Their results also indicated that CAT could be effective in helping those with Bipolar disorder recognize patterns of mood variability (Evans, Kellett, Heyland, Hall, & Majid, 2016).
More research should be done into the effectiveness of CAT in treating the symptoms of Bipolar Disorder. Family-focused psychoeducational treatment (FFT)Miklowitz et al. (2000) ran a randomized controlled design study to examine the 9 month outcome of bipolar patients receiving family-focused psychoeducational treatment (FFT) versus those receiving traditional treatment only. Patients were recruited shortly after a bipolar episode and assigned to either 21 sessions of FFT or 2 family education sessions and follow-up crisis management (CM), both in combination with mood stabilizing medication, administered over 9 months.
FFT involves both the patient and at least one family member receiving extensive education about bipolar disorder, symptoms, causes and treatments, as well as identifying that individual’s signs of illness. They also learn both communication and problem-solving skills. Those patients assigned to CM received typical bipolar treatment with limited family education. Patients who received FFT had few relapses and longer delays between relapse than did patients receiving CM. Those receiving FFT also showed greater improvement in depressive symptoms than those receiving CM (the difference was moderate), although no difference was shown in manic symptoms.
These results show that family-focused psychoeducational treatment can be effect in combination with pharmacotherapy in patients with bipolar disorder.Cognitive-behavioral therapy (CBT) and interpersonal therapyThe goals of treatment for bipolar 1 are more than just symptom recovery provided by pharmacotherapy. Functional recovery is important as well and there is strong evidence that psychotherapy aids in parts of functional recovery such as reducing the risk of recurrence, aiding in adjustment to the illness, family support, and recognizing early signs of symptoms (Colom & Vieta, 2004).
CBT helps reduce symptoms of anxiety and insomnia, reduces the risk of suicide, aids in treatment compliance, improves functioning between episodes, and and reduces impairment (Colom & Vieta, 2004). In addition, it provides emotional support and aids in coping with the consequences of past and present episodes, which pharmacotherapy alone cannot do. For those suffering from bipolar 1 and experiencing post-manic “downs,” psychotherapy is particular helpful (Colom & Vieta, 2004). Antidepressants should be avoided to prevent another manic episode but psychotherapy can teach techniques self-control techniques, stress management, and coping strategies and CBT has been shown particular useful in rapid-cycling bipolar patients (Colom & Vieta, 2004).Group interpersonal and social rhythm therapy (IPSRT)Hoberg, Ponto, Nelson and Frye (2013) ran a two year randomized controlled trial to study the effects of IPSRT on lengthening the time between bipolar episodes.
IPSRT concentrates on adherence to medication, interpersonal stressors (such as relationship conflict, grief, or life changes), and establishing daily routines, or “social rhythm” (which help regulate sleep, energy, and mood). The thought is that managing stress and maintaining a routine will improve social, occupational and home functioning despite bipolar symptoms and hopefully, may aid in decreasing recurrence. To test this, patients were given two individual IPSRT sessions, six group IPSRT sessions, and a 12 week follow-up phone call. The findings showed that the first significant improvement was notable at 12 weeks after starting therapy. This may be due to the fact that time is needed to control symptoms before functioning can improve. Although this therapy has promise, it should be noted that the only patients who completed the trial were female.