TY - JOUR

T1 - Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission

T2 - A systematic review

AU - Seeberg, Michael

AU - Nielsen, I. B.

AU - Jorgensen, C. K.

AU - Eskestad, N. D.

AU - Miskowiak, K. W.

PY - 2021/1/15

Y1 - 2021/1/15

N2 - Background: Anxiety symptoms are prevalent in bipolar disorder (BD) even during periods of remission and impede treatment efficacy, prognosis and functional capacity. This highlights a pressing clinical need to identify novel effective anxiety treatments. This systematic review aimed to evaluate the evidence within the field.Methods: Following PRISMA guidelines, we conducted a systematic search on PubMed, PsycInfo, EMBASE and Cochrane Library for randomised controlled trials (RCTs) targeting anxiety in remitted BD patients.Results: We identified 10 RCTs investigating the effects of psychological or pharmacological treatments on anxiety in remitted BD patients. Two studies of transdiagnostic personalised cognitive behavioural therapy (CBT) found a treatment-related reduction in anxiety. This evidence was preliminary given small sample size and use of self-report measures in a single-blind trial design, respectively. The remaining six psychological intervention trials provided more preliminary evidence due to several methodological challenges. The two pharmacological studies found anxiolytic effects of add-on olanzapine or methylene blue to lithium treatment, respectively. Nevertheless, this evidence should be interpreted with caution given high drop-out rates and substantial side effects that may have impeded blinding.Limitations: We did not conduct a quantitative meta-analysis.Conclusions: There is preliminary evidence for beneficial effects of modified CBT and add-on pharmacotherapy on residual anxiety in BD. Future trials should pre-screen participants for anxiety, define one clinician-rated anxiety measurement as a primary outcome, and employ intention-to-treat analysis to assess treatment effect. This will advance treatment development and enable personalised approaches to address residual anxiety in BD, which has great clinical relevance.

AB - Background: Anxiety symptoms are prevalent in bipolar disorder (BD) even during periods of remission and impede treatment efficacy, prognosis and functional capacity. This highlights a pressing clinical need to identify novel effective anxiety treatments. This systematic review aimed to evaluate the evidence within the field.Methods: Following PRISMA guidelines, we conducted a systematic search on PubMed, PsycInfo, EMBASE and Cochrane Library for randomised controlled trials (RCTs) targeting anxiety in remitted BD patients.Results: We identified 10 RCTs investigating the effects of psychological or pharmacological treatments on anxiety in remitted BD patients. Two studies of transdiagnostic personalised cognitive behavioural therapy (CBT) found a treatment-related reduction in anxiety. This evidence was preliminary given small sample size and use of self-report measures in a single-blind trial design, respectively. The remaining six psychological intervention trials provided more preliminary evidence due to several methodological challenges. The two pharmacological studies found anxiolytic effects of add-on olanzapine or methylene blue to lithium treatment, respectively. Nevertheless, this evidence should be interpreted with caution given high drop-out rates and substantial side effects that may have impeded blinding.Limitations: We did not conduct a quantitative meta-analysis.Conclusions: There is preliminary evidence for beneficial effects of modified CBT and add-on pharmacotherapy on residual anxiety in BD. Future trials should pre-screen participants for anxiety, define one clinician-rated anxiety measurement as a primary outcome, and employ intention-to-treat analysis to assess treatment effect. This will advance treatment development and enable personalised approaches to address residual anxiety in BD, which has great clinical relevance.

KW - Bipolar disorder

KW - Treatment efficacy

KW - Anxiety

KW - Remission

KW - Psychological intervention

KW - Pharmacological intervention

KW - QUALITY-OF-LIFE

KW - TREATMENT ENHANCEMENT PROGRAM

KW - TERM BENZODIAZEPINE USE

KW - COMORBID ANXIETY

KW - COGNITIVE THERAPY

KW - TASK-FORCE

KW - TRANSDIAGNOSTIC TREATMENT

KW - INTERNATIONAL SOCIETY

KW - SPECTRUM DISORDERS

KW - MOOD DISORDERS

U2 - 10.1016/j.jad.2020.09.119

DO - 10.1016/j.jad.2020.09.119

M3 - Review

C2 - 33038698

VL - 279

SP - 31

EP - 45

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -