Question: In adults with a diagnosis of bipolar disorder, how effective is medication combined with focused psychotherapy or cognitive behavioural therapy (CBT), compared to medication alone, in reducing relapse?

Answer:

Evidence from three randomised controlled trials (RCTs) indicates that various psychological interventions (including cognitive behavioural therapy (CBT), family-focussed therapy (FFT) and interpersonal and social-rhythm therapy), when used in combination with pharmacotherapy to treat patients with bipolar disorder, are likely to result in fewer relapses/hospitalisations than pharmacotherapy alone. One of these RCTs, reported a reduction in hospitalisations for patients with refractory bipolar disorder who were treated with a combination of psychoeducational intervention, CBT and pharmacotherapy, compared to those who were treated with pharmacotherapy alone. All studies in this evidence summary reported results which indicated improvements in symptoms and/or function in patients with bipolar disorder who were treated with psychological interventions combined with pharmacotherapy compared to those who were treated with pharmacotherapy alone. These results are likely to be reliable, but further larger RCTs would be useful to confirm findings and to explore which psychological therapies are likely to be most effective.