OBJECTIVES: Assess the effect of psychosocial and other non-drug interventions for treating acute symptoms (depression, mania, and lack of function) associated with bipolar disorder (BD) and preventing relapse.

METHODS: We searched Ovid MEDLINE®, Embase®, PsychInfo, the Cochrane Central Register of Controlled Trials, and hand searched references of relevant systematic reviews through May 2017. Eligible studies included randomized controlled trials and prospective cohorts with comparator arms enrolling adults with BD of any type with 3 weeks follow-up for acute mania, 3 months for depression, and 6 months for maintenance treatments. We excluded studies with greater than 50 percent attrition. We examined studies by both intervention category and comparator type (inactive and active).

RESULTS: We qualitatively synthesized evidence from 63 publications reporting 48 unique studies. A further 6 studies were excluded for high attrition. Clinical states of enrolled subjects and interventions within categories varied greatly. Cognitive behavioral training was no better for depression or mania symptoms than psychoeducation or other active psychosocial comparators (low-strength evidence). Systematic/collaborative care had no effect on relapse compared to inactive comparators (low-strength evidence). Evidence was insufficient for all other interventions and outcomes.

CONCLUSIONS: We were generally unable to draw conclusions about the effect of non-drug interventions for bipolar disorders, largely due to population and intervention heterogeneity. While excluding 12.5 percent of unique studies due to high attrition limited the evidence base, the findings from these studies were of questionable validity. Psychosocial interventions may provide benefits not measured in the reviewed literature. Many of the interventions included components of disease education, discussion of triggers, and coping mechanisms. Providing such information may help patients accept their diagnosis, which can provide benefits in terms of other outcomes such as adherence to pharmacological treatment.