Talk it out...

For decades, lithium was the front-line treatment for bipolar disorder. The mysterious salt—doctors still don’t know exactly how it works—stabilizes the intense high and low moods that are hallmarks of the illness.

But after its use for nearly 40 years (the U.S. Food and Drug Administration approved lithium for control of manic episodes in 1970), doctors and consumers have come to the realization that lithium—as well as other mood stabilizing medications—are not the cure-alls initially hoped for.

“It took the field about 25 years to notice that outcomes were not always so good,” says Ellen Frank, PhD, a psychologist and a professor of psychiatry and psychology at the University of Pittsburgh School of Medicine, and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic.

“We don’t know why [people] relapsed—whether there was a non-adherence to medication, or if the early results for lithium were overly optimistic or there was a co-morbid use of illicit drugs, or a combination of those things,” Frank says.

Indeed, lithium’s limitations led researchers to reexamine psychotherapy’s role and potential. In the 1950s and 1960s, therapy for bipolar consisted chiefly of psychoanalysis, founded by Freud; and psycho dynamic therapy, which focuses on a patient’s previous experiences to understand current conflicts, according to Gregory Simon, MD, a psychiatrist and researcher at Group Health Cooperative, a consumer-governed, nonprofit health-care system based in Seattle, Washington.

“Then more came out about the inheritability of the illness, which led people to look for [other] treatments,” says Simon, who is also chair of the Scientific Advisory Board of the Depression and Bipolar Support Alliance (DBSA).

Over the past decade or so, researchers have developed several psychotherapies that are specifically designed for the treatment of bipolar disorder. Most of these therapies, including cognitive behavioral therapy (CBT) and interpersonal social rhythm therapy (IPSRT), were retooled from existing therapies for other mental illnesses, such as those for anxiety and depression, according to researchers.

Early results have been promising: Clinical studies indicate that therapies targeted for bipolar—when combined with appropriate medication—result in greater mood stability and medication compliance, reduction or elimination of hospitalizations, a faster recovery from a bipolar depression, and better overall quality of life.

According to Joseph R. Calabrese, MD, bipolar disorders research chair and professor of psychiatry at Case Western Reserve University, “The best treatment for bipolar disorder includes both a mood stabilizer, which is used to prevent future mood episodes; and psychotherapy/counseling, which is used to help people learn how to manage the symptoms of their illness. Either alone does not work as well.”

Excerpt from Psychotherapy retooled from the Fall 2008 issue of bp Magazine