The STEP-BD study is an NIMH-funded study of patients with bipolar disorder, which has already yielded a number of intrigu- ing findings, some of which we covered in an earlier issue (TCPR, Aug 2006). This study followed 293 patients with acute depression, most of whom received both mood stabilizers and antidepressants. These patients were randomly assigned to intensive psychother- apy (30 sessions over 9 months) or “collabo- rative care” (3 visits over 6 weeks). Patients in the intensive psychotherapy group had a 64% recovery rate vs. 51% for the collaborative care group (statistically significant at p=.01). The psychotherapies used in this study included cognitive behavior therapy, family-focused therapy, and interpersonal and social rhythm therapy. There were no signifi- cant differences in effectiveness of the thera- pies (Miklowitz DJ et al., Arch Gen Psychiatry 2007;64:419-427).

TCPR’s Take: Patients with bipolar dis- order and depression are difficult to treat, because antidepressants are often not helpful. In fact, one of the major findings of STEP- BD was that adjunctive antidepressants – Paxil or Wellbutrin – did no better than placebo when added to mood stabilizers for acute bipolar depression (Sachs GS et al., NEJM 2007;356:1-12). This study suggests that just about any intensive psychotherapy can boost the effects of mood stabilizers better in bipolar depression than adjunctive antidepressants.