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Advances in Psychiatric Treatment (2003) 9: 110-116
© 2003 The Royal College of Psychiatrists

Combining cognitive therapy with medication in bipolar disorder

Edward Watkins

Edward Watkins is a chartered clinical psychologist and research fellow in the cognitive clinical psychology of depression at the Department of Psychology, Institute of Psychiatry (De Crespigny Park, Denmark Hill, London SE5 8AF, UK). His research interests are cognitive processing in affective disorders and psychological treatments of unipolar and bipolar depression.

Although mood stabilisers have substantially improved the treatment of bipolar disorder, recent studies suggest that treatment with lithium is not as effective as originally claimed. Furthermore, patients still have high rates of relapse even when prescribed medication. Recent research has shown that poor coping strategies in response to bipolar prodromes and disruptions of sleep and social routines increase the risk of relapse. Combining a psychosocial approach with medication may improve the rate of relapse prevention. Cognitive therapy teaches patients better self-monitoring and coping skills and is therefore an appropriate means of minimising psychosocial risk factors for relapse. Recent randomised controlled trials suggest that combined medication and cognitive therapy significantly reduce bipolar relapse compared with medication alone.