Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission: A systematic review

I Seeberg; I B Nielsen; C K Jørgensen; N D Eskestad; K W Miskowiak

doi:10.1016/j.jad.2020.09.119

Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission: A systematic review

J Affect Disord. 2021 Jan 15:279:31-45. doi: 10.1016/j.jad.2020.09.119. Epub 2020 Oct 1.

Authors

I Seeberg¹, I B Nielsen², C K Jørgensen¹, N D Eskestad¹, K W Miskowiak³

Affiliations

¹ Neurocognition and Emotion in Affective Disorder (NEAD) Group; Copenhagen Affective Disorder Research Centre (CADIC); Psychiatric Centre Copenhagen, Copenhagen University Hospital; Department of Psychology, University of Copenhagen.
² Department of Psychology, University of Copenhagen.
³ Neurocognition and Emotion in Affective Disorder (NEAD) Group; Copenhagen Affective Disorder Research Centre (CADIC); Psychiatric Centre Copenhagen, Copenhagen University Hospital; Department of Psychology, University of Copenhagen. Electronic address: kamilla.woznica.miskowiak@regionh.dk.

PMID: 33038698
DOI: 10.1016/j.jad.2020.09.119

Abstract

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.

Keywords: Anxiety; Bipolar disorder; Pharmacological intervention; Psychological intervention; Remission; Treatment efficacy.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Anxiety
Anxiety Disorders / drug therapy
Bipolar Disorder* / complications
Bipolar Disorder* / drug therapy
Cognitive Behavioral Therapy*
Humans
Treatment Outcome