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Original Research Focus on Psychotherapy September 29, 2025

Effects of Interpersonal and Social Rhythm Therapy on Suicidal Ideation in Adults With Bipolar II Depression

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J Clin Psychiatry 2025;86(4):24m15768

Abstract

Objective: Individuals with bipolar II disorder (BD II) have among the highest rates of suicide ideation (SI), attempts, and deaths. No studies to date have examined psychosocial treatment of SI in adults with BD II. The purpose of this study was to investigate whether patients with BD II depression receiving interpersonal and social rhythm therapy (IPSRT), an evidence-based psychotherapy for BD, experienced a decrease in SI, and whether this varied by use of adjunctive medication compared to IPSRT monotherapy.

Methods: In a post hoc analysis of Swartz et al (2018), adults meeting DSM-IV criteria for BD II, currently depressed (n=92), were randomly assigned to receive IPSRT+placebo (IPSRT+P) or IPSRT+quetiapine (IPSRT+Q) and treated for 20 weeks. SI was assessed at baseline and weekly using the 17-item Hamilton Depression Rating Scale item 3. Multilevel logistic regression was used to model SI categorically.

Results: The results demonstrate a decrease in odds of SI over time (OR=0.8719, 95% CI, 0.8166–0.9309, P≤.001), with a 13% decrease in the odds of having SI for each additional week of treatment. There was no significant difference between those receiving IPSRT+P vs IPSRT+Q.

Conclusions: IPSRT has the potential to mitigate suicidal ideation in patients with BD II depression, regardless of whether they receive medication in addition to IPSRT. IPSRT alone may be a reasonable option to treat SI in an outpatient setting for some patients with BD II, especially those for whom medication is contraindicated or who prefer avoiding medication.

Trial Registration: ClinicalTrials.gov identifier: NCT01133821.

J Clin Psychiatry 2025;86(4):24m15768
Author affiliations are listed at the end of this article.

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