Depression, Bipolar & Grief Counselling Blog

Combination therapy is more effective at preventing recurrence of bipolar disorder

A study conducted by Prof. David Miklowitz, author of the excellent ‘The Bipolar Disorder Survival Guide, Third Edition: What You and Your Family Need to Know‘, strongly suggests that a combination of psychoeducation and medication is the most effective treatment for bipolar disorder.

Bipolar Disorder Survival Guide book cover

The findings were:

  • Psychoeducation with guided practice of illness management skills (for example, how to keep regular sleep and wake cycles) in a family or group format was more effective in reducing recurrences of mania and depressive symptoms than the same strategies in an individual therapy format.
  • Cognitive behavioral therapy, family therapy and interpersonal therapy were better at stabilizing depressive symptoms than other forms of treatment.
  • Rates of dropout were lower in patients who received family-oriented therapies.

The paper, published in the prestigious JAMA Psychiatry, went on to say:

Not everyone may agree with me, but I think the family environment is very important in terms of whether somebody stays well. There’s nothing like having a person who knows how to recognize when you’re getting ill and can say, ‘you’re starting to look depressed or you’re starting to get ramped up.’ That person can remind their loved one to take their medications or stay on a regular sleep-wake cycle or contact the psychiatrist for a medication evaluation.”

“If you’re in group therapy, other members of that group may be able to help you recognize that you’re experiencing symptoms,” he said. “People tend to pair off. It’s a little bit like the AA model of having a sponsor.”

Prof. David Miklowitz

Miklowitz, D. J., et al. (2020) Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis. JAMA Psychiatry. doi.org/10.1001/jamapsychiatry.2020.2993.

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