title: Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00012558.
authors.affiliation: Department of Psychology, University of Colorado, Boulder, CO 80309-0345, USA. miklow@psych.colorado.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Noreen A
authors.initials: NA
authors.lastname: Reilly-Harrington
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Jane N
authors.initials: JN
authors.lastname: Kogan
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Marangell
authors.forename: Laszlo
authors.initials: L
authors.lastname: Gyulai
authors.forename: Mako
authors.initials: M
authors.lastname: Araga
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Gonzalez
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Shirley
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Gary S
authors.initials: GS
authors.lastname: Sachs
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000927:Anticonvulsants / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005196:Family Therapy; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D010352:Patient Dropouts; D010353:Patient Education as Topic; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D018020:Lithium Compounds