Applied Evidence

A primary care guide to bipolar depression treatment

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FFT focuses on communication styles between patients and their spouses and families. The goal is to improve relationship functioning. FFT is delivered to the patient and the family.

Attention to social factors. For psychotherapy to provide adequate results as an adjunct to pharmacotherapy, social stressors (eg, homelessness and financial concerns) might also need to be considered and addressed through social services or a social work consult.

NICE guidelines recommend psychological intervention (in particular, with CBT and FFT) for acute BD. CANMAT–ISBD guidelines recommend either adjunctive psychoeducation, CBT, or FFT during the maintenance phase. Again, medication is the mainstay of treatment for BD in bipolar disorders; psychotherapy has an adjunctive role—unlike the approach to treatment of MDD, in which psychotherapy can be used alone in cases of mild, or even moderate, severity.

Referral for specialty care

In the primary care setting, providers might choose to manage BD by initiating first-line pharmacotherapeutic agents or continuing established treatment regimens with necessary dosage adjustments. These patients should be monitored closely until symptoms remit.

However, it is important for the primary care provider to identify patients who need psychiatric referral. Complex presentations, severe symptoms, and poor treatment response might warrant evaluation and management by a psychiatrist. Furthermore, patients with comorbid psychotic features, catatonia, or severely debilitating depression (with or without suicidality) need referral to the emergency department.

Continue to: Electroconvulsive therapy (ECT)

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