Lithium, the first drug treatment used for bipolar disorder, was considered so effective when it was introduced that medication has been the primary focus of bipolar treatment ever since. Relatively little attention has been paid to psychosocial treatments for bipolar disorder, a condition characterized by alternating depression and mania.
While psychotherapy was routinely used during the 20th century, it had little to offer manic patients who suffer from marked impairments in insight, said Holly A. Swartz, M.D., associate professor of psychiatry at the University of Pittsburgh School of Medicine in Pennsylvania.
Writing in the journal Focus, Swartz states, “Toward the end of the 20th century, it became increasingly apparent that medication offered only partial relief from bipolar disorder. Treatment with pharmacologic interventions alone was associated with disappointingly low rates of remission, high rates of recurrence, residual symptoms, and psychosocial impairment.”
But she adds, “Gradually, the field moved from conceptualizing bipolar disorder as a disorder requiring only medication to an illness that, like many chronic disorders, is best treated using a combination of pharmacotherapy and psychotherapy.”
Talk therapies for bipolar disorder, such as cognitive-behavioral therapy, are potentially very useful because the condition involves psychosocial and interpersonal dysfunction, as well as a low rate of adherence to medication.
“Each of these domains is reasonably addressed by psychotherapeutic interventions, especially when delivered in combination with pharmacotherapy,” Swartz writes.