Psychosocial Treatments for Bipolar Depression: A 1-Year Randomized Trial From the Systematic Treatment Enhancement Program | Bipolar and Related Disorders | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.185.54. Please contact the publisher to request reinstatement.
1.
Gitlin  MJSwendsen  JHeller  TLHammen  C Relapse and impairment in bipolar disorder.  Am J Psychiatry 1995;1521635- 1640PubMedGoogle Scholar
2.
Coryell  WScheftner  WKeller  MEndicott  JMaser  JKlerman  GL The enduring psychosocial consequences of mania and depression.  Am J Psychiatry 1993;150720- 727PubMedGoogle Scholar
3.
Judd  LLAkiskal  HSSchettler  PJCoryell  WEndicott  JMaser  JDSolomon  DALeon  ACKeller  MB A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder.  Arch Gen Psychiatry 2003;60261- 269PubMedGoogle ScholarCrossref
4.
Judd  LLAkiskal  HSSchettler  PJEndicott  JMaser  JSolomon  DALeon  ACRice  JAKeller  MB The long-term natural history of the weekly symptomatic status of bipolar I disorder.  Arch Gen Psychiatry 2002;59530- 537PubMedGoogle ScholarCrossref
5.
Calabrese  JRHirschfeld  RMFrye  MAReed  ML Impact of depressive symptoms compared with manic symptoms in bipolar disorder: results of a U.S. community-based sample.  J Clin Psychiatry 2004;651499- 1504PubMedGoogle ScholarCrossref
6.
Hlastala  SAFrank  EMallinger  AGThase  MERitenour  AMKupfer  DJ Bipolar depression: an underestimated treatment challenge.  Depress Anxiety 1997;573- 83PubMedGoogle ScholarCrossref
7.
Kupfer  DJFrank  EGrochocinski  VJLuther  JFHouck  PRSwartz  HAMallinger  AG Stabilization in the treatment of mania, depression, and mixed states.  Acta Neuropsychiatrica 2000;12110- 114Google Scholar
8.
Tohen  MWaternaux  CMTsuang  MT Outcome in mania: a 4-year prospective follow-up of 75 patients utilizing survival analysis.  Arch Gen Psychiatry 1990;471106- 1111PubMedGoogle ScholarCrossref
9.
Tohen  MSuppes  TBaker  RWRisser  RCEvans  ARCalabrese  JR Olanzapine combined with mood stabilizers in prevention of recurrence in bipolar disorder: an 18-month study.  Eur Neuropsychopharmacol 2002;12 ((suppl 3)) 530- 537Google Scholar
10.
Gelenberg  AJKane  JNKeller  MBLavori  PRosenbaum  JFCole  KLavelle  J Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorders.  N Engl J Med 1989;3211489- 1493PubMedGoogle ScholarCrossref
11.
Thase  MESachs  GS Bipolar depression: pharmacotherapy and related therapeutic strategies.  Biol Psychiatry 2000;48558- 572PubMedGoogle ScholarCrossref
12.
Cochran  SD Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders.  J Consult Clin Psychol 1984;52873- 878PubMedGoogle ScholarCrossref
13.
Lam  DHHayward  PWatkins  ERWright  KSham  P Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years.  Am J Psychiatry 2005;162324- 329PubMedGoogle ScholarCrossref
14.
Miklowitz  DJGeorge  ELRichards  JASimoneau  TLSuddath  RL A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder.  Arch Gen Psychiatry 2003;60904- 912PubMedGoogle ScholarCrossref
15.
Rea  MMTompson  MMiklowitz  DJGoldstein  MJHwang  SMintz  J Family focused treatment vs. individual treatment for bipolar disorder: results of a randomized clinical trial.  J Consult Clin Psychol 2003;71482- 492PubMedGoogle ScholarCrossref
16.
Clarkin  JFGlick  IDHaas  GLSpencer  JHLewis  ABPeyser  JDemane  NGood-Ellis  MHarris  ELestelle  V A randomized clinical trial of inpatient family intervention, V: results for affective disorders.  J Affect Disord 1990;1817- 28PubMedGoogle ScholarCrossref
17.
Clarkin  JFCarpenter  DHull  JWilner  PGlick  I Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses.  Psychiatr Serv 1998;49531- 533PubMedGoogle Scholar
18.
Fristad  MAGavazzi  SMMackinaw-Koons  B Family psychoeducation: an adjunctive intervention for children with bipolar disorder.  Biol Psychiatry 2003;531000- 1009PubMedGoogle ScholarCrossref
19.
Frank  EKupfer  DJThase  MEMallinger  AGSwartz  HAFagiolini  AMGrochocinski  VJHouck  PScott  JThompson  WMonk  T Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder.  Arch Gen Psychiatry 2005;62996- 1004PubMedGoogle ScholarCrossref
20.
Colom  FVieta  EMartinez-Aran  AReinares  MGoikolea  JMBenabarre  ATorrent  CComes  MCorbella  BParramon  GCorominas  J A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission.  Arch Gen Psychiatry 2003;60402- 407PubMedGoogle ScholarCrossref
21.
Simon  GELudman  EJBauer  MSUnutzer  JOperskalski  B Long-term effectiveness and cost of a systematic care program for bipolar disorder.  Arch Gen Psychiatry 2006;63500- 508PubMedGoogle ScholarCrossref
22.
Scott  JPaykel  EMorriss  RBentall  RKinderman  PJohnson  TAbbott  RHayhurst  H Cognitive behaviour therapy for severe and recurrent bipolar disorders: a randomised controlled trial.  Br J Psychiatry 2006;188313- 320PubMedGoogle ScholarCrossref
23.
Miklowitz  DJ A review of evidence-based psychosocial interventions for bipolar disorder.  J Clin Psychiatry 2006;67 ((suppl 11)) 28- 33PubMedGoogle Scholar
24.
Miklowitz  DJOtto  MW New psychosocial interventions for bipolar disorder: a review of literature and introduction of the Systematic Treatment Enhancement Program.  J Cogn Psychother 2006;20215- 230Google ScholarCrossref
25.
Sachs  GSThase  MEOtto  MWBauer  MMiklowitz  DWisniewski  SRLavori  PLebowitz  BRudorfer  MFrank  ENierenberg  AAFava  MBowden  CKetter  TMarangell  LCalabrese  JKupfer  DRosenbaum  JF Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD).  Biol Psychiatry 2003;531028- 1042PubMedGoogle ScholarCrossref
26.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Text Revision) (DSM-IV-TR).  Washington, DC: American Psychiatric Press;2000;
27.
First  MBSpitzer  RLGibbon  MWilliams  JBW Structured Clinical Interview for DSM-IV Axis I Disorders.  New York: Biometrics Research Department, New York State Psychiatric Institute;1995;
28.
Sachs  GS Use of clonazepam for bipolar affective disorder.  J Clin Psychiatry 1990;5131- 34PubMedGoogle Scholar
29.
Sheehan  DVLecrubier  YSheehan  KHAmorim  PJanavs  JWeiller  EHergueta  TBaker  RDunbar  GC The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10 J Clin Psychiatry 1998;59 ((suppl 20)) 22- 33PubMedGoogle Scholar
30.
Otto  MWReilly-Harrington  NA Cognitive-behavior therapy for the management of bipolar disorder. Hofmann  SGTompson  MC eds. Handbook of Psychosocial Treatments for Severe Mental Disorders. New York, NY: Guilford Press;2002;116- 130Google Scholar
31.
Frank  E Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social Rhythm Therapy.  New York, NY: Guilford Press;2005;
32.
Monk  THKupfer  DJFrank  ERitenour  AM The Social Rhythm Metric (SRM): measuring daily social rhythms over 12 weeks.  Psychiatry Res 1991;36195- 207PubMedGoogle ScholarCrossref
33.
Miklowitz  DJGoldstein  MJ Bipolar Disorder: A Family-Focused Treatment Approach.  New York, NY: Guilford Press;1997;
34.
Miklowitz  DJGoldstein  MJNuechterlein  KHSnyder  KSMintz  J Family factors and the course of bipolar affective disorder.  Arch Gen Psychiatry 1988;45225- 231PubMedGoogle ScholarCrossref
35.
Otto  MWSimon  NMWisniewski  SRMiklowitz  DJKogan  JNReilly-Harrington  NAFrank  ENierenberg  AAMarangell  LBSagduyu  KWeiss  RDMiyahara  SThase  MESachs  GSPollack  MHSTEP-BD Investigators, Prospective 12-month course of bipolar disorder in outpatients with and without comorbid anxiety disorders.  Br J Psychiatry 2006;18920- 25PubMedGoogle ScholarCrossref
36.
Montgomery  SAAsberg  M A new depression scale designed to be sensitive to change.  Br J Psychiatry 1979;134382- 389PubMedGoogle ScholarCrossref
37.
Young  RCBiggs  JTZiegler  VEMeyer  DA A rating scale for mania: reliability, validity, and sensitivity.  Br J Psychiatry 1978;133429- 435PubMedGoogle ScholarCrossref
38.
Kaplan  ELMeier  P Nonparametric estimation from incomplete observations.  J Am Stat Assoc 1958;53457- 481Google ScholarCrossref
39.
Kalbfleisch  JDPrentice  RL The Statistical Analysis of Failure Time Data.  New York, NY: John Wiley & Sons; 1980;
40.
Cox  DR Regression models and life tables.  J R Stat Soc [Ser B] 1972;34187- 220Google Scholar
41.
Hedeker  D A mixed-effects multinomial logistic regression model.  Stat Med 2003;221433- 1446PubMedGoogle ScholarCrossref
42.
Liu  LCHedeker  D A mixed-effects regression model for longitudinal multivariate ordinal data.  Biometrics 2006;62261- 268PubMedGoogle ScholarCrossref
43.
Keck  PEPerlis  RHOtto  MWCarpenter  DDocherty  JPRoss  R Expert Consensus Guideline Series: treatment of bipolar disorder.  Postgrad Med December 2004;1- 108Google Scholar
44.
Lembke  AMiklowitz  DJOtto  MWZhang  HWisniewski  SRSachs  GSThase  MEKetter  TA Psychosocial service utilization by patients with bipolar disorders: data from the first 500 participants in the Systematic Treatment Enhancement Program.  J Psychiatr Pract 2004;1081- 87PubMedGoogle ScholarCrossref
45.
Ghaemi  SNLenox  MSBaldessarini  RJ Effectiveness and safety of long-term antidepressant treatment in bipolar disorder.  J Clin Psychiatry 2001;62565- 569PubMedGoogle ScholarCrossref
46.
Scott  JGutierrez  MJ The current status of psychological treatments in bipolar disorders: a systematic review of relapse prevention.  Bipolar Disord 2004;6498- 503PubMedGoogle ScholarCrossref
47.
Mansell  WColom  FScott  J The nature and treatment of depression in bipolar disorder: a review and implications for future psychological investigation.  Clin Psychol Rev 2005;251076- 1100PubMedGoogle ScholarCrossref
48.
Scott  J Treatment outcome studies. Johnson  SLLeahy  RL eds. Psychological Treatment of Bipolar Disorder. New York, NY: Guilford Press;2004:;226- 241Google Scholar
49.
Lam  DHWatkins  ERHayward  PBright  JWright  KKerr  NParr-Davis  GSham  P A randomized controlled study of cognitive therapy of relapse prevention for bipolar affective disorder: outcome of the first year.  Arch Gen Psychiatry 2003;60145- 152PubMedGoogle ScholarCrossref
50.
Miklowitz  DJOtto  MWWisniewski  SRAraga  MFrank  EReilly-Harrington  NLembke  ASachs  GS Psychotherapy, symptom outcomes, and role functioning over one year among patients with bipolar disorder.  Psychiatr Serv 2006;57959- 965PubMedGoogle ScholarCrossref
Original Article
April 2007

Psychosocial Treatments for Bipolar Depression: A 1-Year Randomized Trial From the Systematic Treatment Enhancement Program

Author Affiliations

Author Affiliations: Departments of Psychology and Psychiatry, University of Colorado, Boulder (Dr Miklowitz); Department of Psychology, Boston University, Boston, Mass (Dr Otto); Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pa (Drs Frank and Thase); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Reilly-Harrington, Nierenberg, and Sachs); Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh (Dr Wisniewski and Ms Araga); Department of Psychiatry, University of Pittsburgh School of Medicine and Community Care Behavioral Health Organization (Dr Kogan); Department of Psychiatry, Case Western Reserve University School of Medicine/University Hospitals of Cleveland, Cleveland, Ohio (Drs Calabrese and Shirley); Menninger Department of Psychiatry, Baylor College of Medicine, and VISN 16 Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Houston, Tex (Dr Marangell); Department of Psychiatry, University of Pennsylvania, Philadelphia (Dr Gyulai); and Department of Psychiatry, University of Texas Health Science Center, San Antonio (Dr Gonzalez).

Arch Gen Psychiatry. 2007;64(4):419-426. doi:10.1001/archpsyc.64.4.419
Abstract

Context  Psychosocial interventions have been shown to enhance pharmacotherapy outcomes in bipolar disorder.

Objective  To examine the benefits of 4 disorder-specific psychotherapies in conjunction with pharmacotherapy on time to recovery and the likelihood of remaining well after an episode of bipolar depression.

Design  Randomized controlled trial.

Setting  Fifteen clinics affiliated with the Systematic Treatment Enhancement Program for Bipolar Disorder.

Patients  A total of 293 referred outpatients with bipolar I or II disorder and depression treated with protocol pharmacotherapy were randomly assigned to intensive psychotherapy (n = 163) or collaborative care (n = 130), a brief psychoeducational intervention.

Interventions  Intensive psychotherapy was given weekly and biweekly for up to 30 sessions in 9 months according to protocols for family-focused therapy, interpersonal and social rhythm therapy, and cognitive behavior therapy. Collaborative care consisted of 3 sessions in 6 weeks.

Main Outcome Measures  Outcome assessments were performed by psychiatrists at each pharmacotherapy visit. Primary outcomes included time to recovery and the proportion of patients classified as well during each of 12 study months.

Results  All analyses were by intention to treat. Rates of attrition did not differ across the intensive psychotherapy (35.6%) and collaborative care (30.8%) conditions. Patients receiving intensive psychotherapy had significantly higher year-end recovery rates (64.4% vs 51.5%) and shorter times to recovery than patients in collaborative care (hazard ratio, 1.47; 95% confidence interval, 1.08-2.00; P = .01). Patients in intensive psychotherapy were 1.58 times (95% confidence interval, 1.17-2.13) more likely to be clinically well during any study month than those in collaborative care (P = .003). No statistically significant differences were observed in the outcomes of the 3 intensive psychotherapies.

Conclusions  Intensive psychosocial treatment as an adjunct to pharmacotherapy was more beneficial than brief treatment in enhancing stabilization from bipolar depression. Future studies should compare the cost-effectiveness of models of psychotherapy for bipolar disorder.

Trial Registration  clinicaltrials.gov Identifier: "http://clinicaltrials.gov/show/NCT00012558">NCT00012558

×