Second, although not all trials have been positive, there is compelling evidence that psychotherapies can be beneficial in augmenting standard pharmacotherapy in bipolar disorder in terms of symptom reduction, episode prophylaxis, and improvement of adherence and psychosocial functioning. Third, there is some evidence, rather surprisingly, that these interventions are better at delaying the onset, of mania than in addressing the active symptoms of depression (the STEP-BD study targeting bipolar depression is a notable Inhibitors,research,lifescience,medical exception). The next, evolution of clinical research on psychotherapy for bipolar

disorder would need to address: (i) which intervention works best for which patients; (ii) how these interventions Inhibitors,research,lifescience,medical can be made available outside of academic medical centers; and (iii) what the essential ingredients of

psychotherapy for bipolar disorder are. Bipolar disorder is an enormously heterogeneous condition, and it is highly likely that therapies would need to target subgroups of people with bipolar Inhibitors,research,lifescience,medical disorder to be adequately personalized. Presently, there are few evidence-based moderators or mediators of treatment effectiveness in bipolar disorder. In their negative trial of CBT for bipolar disorder, Scott et al20 found that individuals with fewer previous episodes appeared to derive Onalespib benefit from treatment, whereas those who had more episodes did not. Although these kinds of mediators require replication over multiple Inhibitors,research,lifescience,medical studies, it. will be important to understand who will and who might not benefit, from augmentation with psychotherapy. In addition

to clinical variables that might moderate outcome, whether and how interventions are accepted and experienced in different ethnic groups deserves study. In psychosocial interventions for other conditions, major efforts have been undertaken to adapt psychosocial treatments to culture-based preferences Inhibitors,research,lifescience,medical and values. There are also efforts under way to modify the above intervention modalities to address subgroups ADP ribosylation factor of people with bipolar disorder, such as those with chronic physical illnesses.32 In addition, understanding how these interventions can be successfully transported to community settings is a needed next step. While approximately half of the STEPBD sample had attended counseling or psychotherapy in the community prior to their enrolment,33 it is doubtful that many have access to the evidence -based psychotlierapies described above. It is also unlikely, due to financing and staffing limitations, that 20-session packages, as implemented in the research studies cited above, will be feasible in many settings.