Patients battling the often crippling effects of bipolar disorder now may have another ally in their fight to control the disease - their own family members.
Researchers at the University of Colorado at Boulder have completed a yearlong study showing that patients who received medication and an experimental family-focused treatment program had fewer episodes of the disease, and longer delays before relapses, than those receiving medication and standard community treatment.
Medication is the first line of defense against the disease, also called manic depression. The disease is caused by a biochemical imbalance in the brain and affects an estimated 3 million Americans. Lithium carbonate and anticonvulsant drugs like valproate (Depakote) are commonly prescribed to help patients level out their moods.
While fully controlling the ups and downs of bipolar disorder is not possible, doctors can delay patients' relapses into debilitating periods of depression and manic behavior. Relapses of the disorder can split up marriages, cause job loss and even lead to suicide, said David Miklowitz, a CU-Boulder psychology professor and lead researcher on the study.
"Few studies have examined treating bipolar disorder with an in-depth family treatment program like this one where the patients received 21 in-home family counseling sessions," Miklowitz said.
While many studies have looked at the value of psychotherapy for bipolar disorder patients, it is still not clear which treatment programs work, or how or when they should be used, according to Miklowitz. The CU-Boulder study is part of an ongoing national effort to evaluate different treatments for the disease.
"One of the main goals of this study was to figure out the conditions under which family treatment is effective, and whether it is more successful than standard treatment methods at reducing the frequency and timing of relapses," Miklowitz said. "The data shows that this is the case, particularly for depressive episodes."
In the CU-Boulder study, patients were randomly assigned to a family-focused treatment program with standard medications like lithium, or to the standard community care generally offered to bipolar disorder patients, consisting of medications and support during emergencies, Miklowitz said. Seventy-one percent of the patients who completed the family-focused program did so without relapsing, compared with only 47 percent of the patients in the standard treatment program. The complete results were reported in the Sept. 15 issue of the journal Biological Psychiatry.
Researchers have long known that bipolar patients living in family situations that are especially hostile or confrontational have higher rates of relapse. But Miklowitz and his group of researchers have developed a treatment program using positive family interaction to help limit the frequency of relapses.
The treatment program, which Miklowitz highlights in the 1997 book "Bipolar Disorder: A Family Focused Treatment Approach," involves educating the patient and family about manic depression, teaching them to communicate successfully and helping them solve the many problems that come with fighting bipolar disorder.
During the first part of the program, patients and their families learn what the disease is and how to recognize symptoms that might mean a relapse is coming.
"There is a window of opportunity where if you catch the symptoms and get the person into treatment, the results are better," Miklowitz said. "The person might need extra family support, or need to stop drinking alcohol, or get on a regular sleeping and waking regimen.
Understanding the disease, and recognizing signs of an oncoming relapse, goes a long way toward helping control the disease."
Learning to communicate and solve problems within the family is also key.
"Communication breakdowns when families are coping with fluctuations of the disorder are common," Miklowitz said. "Part of the treatment program involves coaching families to interact in a positive way and tackle problems systematically."
Teresa Simoneau, Elizabeth George, Jeffrey Richards and Aparna Kalbag of CU-Boulder's psychology department all contributed to the research. Natalie Sachs-Ericsson of Florida State's psychology department and Richard Suddath, a psychiatrist in private practice in Boulder, also contributed.
The research was funded by the National Institute of Mental Health.