Non-pharmacological treatment for bipolar disorder from psychosocial treatment to digital therapy: a narrative review

초록

Purpose: Although bipolar disorder requires lifelong pharmacotherapy to prevent recurrence, many patients continue to experience residual symptoms and relapses despite optimal medication. As a result, non-pharmacological interventions are increasingly recognized as essential adjuncts for improving clinical outcomes. This narrative review summarizes promising non-pharmacological approaches for the treatment of bipolar disorder. Current concepts: Non-pharmacological strategies for bipolar disorder include psychosocial interventions, neuromodulation, and digital therapeutics. Among psychosocial treatments, psychoeducation, cognitive behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer support programs have demonstrated varying levels of evidence for improving depressive symptoms and preventing recurrence. In the domain of neuromodulation, electroconvulsive therapy remains the most established and effective option for treatment-resistant bipolar disorder. Invasive techniques such as vagus nerve stimulation and deep brain stimulation show potential benefits in refractory cases, whereas noninvasive methods, including transcranial magnetic stimulation and transcranial direct-current stimulation, are generally more accessible and better tolerated. Digital therapeutics, which encompass mobile-or web-based behavioral interventions, remain in early stages of development but demonstrate emerging feasibility and potential clinical utility. Discussion and conclusion: Despite continued advances in pharmacotherapy, a substantial proportion of patients with bipolar disorder fail to achieve complete remission. Non-pharmacological treatments may complement pharmacological strategies by addressing psychosocial and neurobiological factors that are not fully targeted by medication alone. Although the current evidence base remains limited, rapid technological advances and growing research efforts may soon establish these interventions as integral components of personalized care for bipolar disorder.

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