Psychosocial interventions as an adjunct to pharmacotherapy in bipolar disorder

Objective: To summarize the evidence and make treatment recommendations regarding the use of psychosocial interventions as an adjunct to pharmacotherapy for bipolar disorder. Methods: We reviewed published outcome studies since 1975 identified in MEDLINE and PsychLIT searches. Results: Available studies are initial and of highly variable methodological rigour. Evidence is most robust for the efficacy of psychoeducation and family therapy, and these received the highest level of recommendation as interventions Group therapy, cognitive-behavioural therapy, and behavioural family management therapy are supported by weaker evidence and received a lower-level treatment recommendation. Availability of only a single interpersonal and social rhythms therapy trial limited the confidence of the recommendation for this intervention. Conclusions: Controlled trials are needed to replicate early outcome studies and guide treatment recommendations. A accumulated evidence of favourable psychosocial intervention outcomes supports, with variable confidence, their use as adjuncts to pharmacotherapy in the treatment of bipolar disorder.