Interpersonal Therapy Shows Promise for Perinatal Bipolar Disorder Management
Key Clinical Summary
- Adapted Interpersonal and Social Rhythm Therapy (IPSRT) demonstrated feasibility and high patient satisfaction in pregnant women with bipolar disorder (BD).
- Significant reductions in depressive symptoms were observed at 4 and 6 months postpartum compared to baseline.
- The intervention incorporated flexible delivery and perinatal-specific adaptations, including sleep regulation, medication counseling, and relapse prevention.
The perinatal period is a high-risk time for mood destabilization in individuals with bipolar disorder (BD). A pilot study published in the Journal of Affective Disorders found that an adapted version of Interpersonal and Social Rhythm Therapy (IPSRT) demonstrated both feasibility and high patient satisfaction across perinatal-specific challenges in pregnant women with BD.
Study Findings
This preliminary study enrolled 14 pregnant women diagnosed with BD to assess a modified 20-session IPSRT intervention. The therapy was adapted to address perinatal-specific challenges, including psychoeducation relevant to pregnancy and postpartum, strategies to enhance social support, and management of sleep-wake disruptions associated with newborn care. Treatment delivery was flexible, allowing sessions in clinic, at home, or by phone.
Participants began the intervention during pregnancy and were followed through 4 months postpartum (end of treatment) and 6 months postpartum (2-month follow-up). Of the 14 participants, 10 (71%) completed follow-up assessments. On average, participants attended 14 out of 20 sessions, indicating moderate engagement.
Feasibility and acceptability outcomes were favorable. Participant satisfaction scores were high, averaging 31.25 out of a possible 32. Depressive symptoms were significantly reduced at both the end of treatment and follow-up compared to baseline; Quick Inventory of Depressive Symptoms-Clinician Rating (QIDS) scores across all time points [mean (standard error) = −1.99 (0.58), p = 0.001, z = −3.46, 95% CI (−3.12 to −087)] demonstrated a 2.0 unit decrease in depression symptom severity unit per unit increase in time. Manic symptoms, which were generally low at baseline, also saw a numerical improvement, although the difference was not statistically significant.
Clinical Implications
These findings suggest that IPSRT may be a viable adjunctive psychotherapy for managing bipolar disorder during the perinatal period. This population faces unique challenges, including hormonal changes, sleep deprivation, and increased psychosocial stress, all of which can exacerbate mood symptoms.
The observed reduction in depressive symptoms is clinically meaningful, given the high burden of perinatal depression in BD and its impact on maternal and infant outcomes. The high satisfaction and retention rates indicate that patients find the intervention acceptable and relevant to their needs.
However, the small sample size and open trial design limit generalizability. The authors recommend a larger qualitative study to investigate the ideal length and format of IPSRT, as well as an additional pilot feasibility test with “a multi-site collaboration to enhance research feasibility prior to engaging in a larger statistically powered efficacy trial.”
Expert Commentary
“This project illustrates the appeal of IPSRT in a perinatal setting,” wrote Shannon N. Lenze, PhD, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, and study coauthors. “Given the high clinical needs of perinatal women with BD, the patient, and providers’ concerns about use of pharmacotherapy during this period, and the limited empirical data to guide treatment recommendations for pregnant and postpartum women with BD, this research is critically needed,” they concluded.
