Using combination antipsychotic treatment has become more common over the years, presumably reflecting a common sense theory that in refractory patients, two medications might be more effective than one. But studies thus far of the practice have been small and inconclusive.
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If you treat patients with bipolar disorder, then you have reached what I call the moment of truth. Your patient has been doing so well, she’s not even sure she still has a psychiatric problem. This is one of the many opportunities for psychotherapy in bipolar disorder—in this case, helping your patient to come to terms with her illness.
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Research has generally found that both antidepressants and psychotherapy offer similar efficacy in the short-term, but that after treatment discontinuation, results are better with psychotherapy.
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I examined results of multiple meta-analyses published in top tier, peer reviewed journals. The findings were clear and consistent: effect sizes for psychodynamic psychotherapy are at least as large as those reported for other therapies that are promoted as “empirically supported” or “evidence based.” Also, the benefits of psychodynamic therapy are lasting. Patients not only improve, but continue to improve even after therapy ends.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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