Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission: A systematic review
Research output: Contribution to journal › Review › Research › peer-review
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.
|Journal||Journal of Affective Disorders|
|Number of pages||15|
|Publication status||Published - 15 Jan 2021|
- Bipolar disorder, Treatment efficacy, Anxiety, Remission, Psychological intervention, Pharmacological intervention, QUALITY-OF-LIFE, TREATMENT ENHANCEMENT PROGRAM, TERM BENZODIAZEPINE USE, COMORBID ANXIETY, COGNITIVE THERAPY, TASK-FORCE, TRANSDIAGNOSTIC TREATMENT, INTERNATIONAL SOCIETY, SPECTRUM DISORDERS, MOOD DISORDERS