Treatment Options for Functional Recovery in Adults with Bipolar II Disorder

Background and Purpose: Growing research on youth and adults with bipolar disorders, including bipolar II disorder, demonstrates substantial functional impairment that often continues for up to a year following symptomatic recovery (i.e. remission of mood symptoms). Indeed, individuals with bipolar disorders identify functional recovery, beyond symptomatic recovery, as essential to meaningful quality of life. Yet, treatment outcome studies in this population generally primarily focus on symptomatic recovery; as such, treatment options to ensure functional recovery have not been investigated. This study examined differences over time in functional recovery in patients receiving quetiapine or placebo in addition to Interpersonal and Social Rhythm Therapy (IPSRT).

Methods: Participants were 77 individuals with BD II, depressed, randomly assigned to IPSRT plus placebo or IPSRT plus quetiapine and treated for 20 weeks. Functional recovery was defined dichotomously by the clinical cut off point on the Functional Assessment Short Test (FAST). That is, total score: ≤ 11 indicating no impairment. Cox regression was used with treatment group as a covariate to determine differences in trajectories of functional recovery between those receiving IPSRT + placebo or IPSRT + quetiapine. Covariates of anxiety disorder, personality disorder and past substance use disorder were examined as predictors of functional recovery and moderators of treatment effect.

Results: Results showed a trend towards participants receiving IPSRT alone being more likely (p = 0.057) to reach functional recovery than those receiving both medication and IPSRT. Comorbidities of anxiety disorder, personality disorder or any lifetime substance use disorder did not predict functional recovery or moderate treatment effect by treatment group.

Conclusions and Implications: Results show psychotherapy alone does no worse than psychotherapy + medication, and may be associated increased probability of functional recovery. These findings are counterintuitive; however, it may be speculated with caution that the side effect burden of medication may impose a barrier to functional recovery for some individuals. These findings have implications informing shared decision making by consumers. Study limitations include absence of an inactive comparator group, a medication only treatment group, small sample size, lack of diversity, and high dropout.