Do psychological interventions reduce symptoms of depression for patients with bipolar I or II disorder? A meta-analysis
Yilmaz, S; Huguet, A; Kisely, S; et al.Rao, S; Wang, J; Baur, K; Price, M; O'Mahen, H; Wright, K
Date: 7 January 2022
Journal
Journal of Affective Disorders
Publisher
Elsevier / International Society for Affective Disorders
Publisher DOI
Abstract
Background: Psychological therapies may play an important role in the treatment of bipolar
disorders. Several meta-analyses that examine the effectiveness of psychotherapies for
patients with bipolar disorder include conclusions about the impact upon bipolar
depression. However, these tend not to consider differences in depression ...
Background: Psychological therapies may play an important role in the treatment of bipolar
disorders. Several meta-analyses that examine the effectiveness of psychotherapies for
patients with bipolar disorder include conclusions about the impact upon bipolar
depression. However, these tend not to consider differences in depression outcome
depending upon whether the therapy primarily targets acute depression, nor severity of
baseline depression. This may affect the conclusions drawn about the effectiveness of these
therapies for acute bipolar depression treatment.
Objectives: This meta-analysis explored the effectiveness of psychological therapies in
reducing bipolar depression, in particular examining whether: (1) the effect of therapy is
greater when baseline depressive symptoms are more severe, and (2) the effect of therapy
is greater when the primary focus of the therapy is the treatment of acute bipolar
depression?
Data sources: A systematic search was conducted using the following electronic databases;
Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980
onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries
(listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html).
Eligibility criteria: Eligible studies were randomized controlled trials evaluating a
psychological intervention for adults diagnosed with Bipolar I or II disorder. The
comparators were usual care, wait-list, placebo, active treatment control. Post-treatment
depression status was required to be measured continuously using a validated self- or
observer- report measure, or categorically by a validated diagnostic instrument or clinical
diagnosis by a suitably qualified person.
Data extraction and synthesis: Titles and abstracts were screened, followed by full texts.
Two reviewers conducted each stage until agreement was reached, and both independently
extracted study information. Means, standard deviations (SDs) and number of participants
were retrieved from articles and used to perform a meta-analysis. The primary outcome was
depressive symptom score.
Results: The database search identified 6388 studies. After removing the duplicates, 3298
studies remained, of which, 28 studies were included in the qualitative review and 22 in the
meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was
low quality evidence of a significant effect on symptoms of depression for cognitive
behavioural therapy and dialectical behaviour therapy. Trials of psychoeducation,
mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy
showed no evidence of any effect on depression. We found no significant relationship
between baseline depression score and depression outcome post-treatment when we
controlled for therapy type and comparator. The result also showed that the effect sizes for
studies targeting acute depression to be tightly clustered around a small overall effect size.
Conclusions: Some psychological therapies may reduce acute bipolar depression although
this conclusion should be viewed with caution given the low quality of evidence. More
research using similar therapy types and comparators is needed to better understand the
relationship between depression status at baseline and outcome.
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