In the study by Geddes, et al., (2010), the researchers investigated monotherapy with either Lithium Carbonate of Valproate Semisodium and combination therapy with both, for Bipolar I. Their goal was to discover if combination therapy was more effective for relapse prevention than either drug alone. This is because while each medication is effective with some people, there are high rates of relapse with each when used alone. The quantitative design used was cox regression analysis to determine if relapse rated differed based on whether individuals were taking either Lithium or Valproate alone or both together. Relapse was defined as a new mood related episode for which treatment was initiated during the two-year follow-up. Experimenters randomly assigned three hundred and thirty subjects to three groups though the experimenters and subjects were made aware of treatment assignment. Results indicated that 54% of the combination group, 59% or the lithium group, and 69% of the valproate group had a primary episode during the two year follow-up period. Significant differences were found between the combination therapy vs. valproate alone and valproate alone vs. lithium alone. While the conclusions suggest that combination therapy might provide lower relapse rate compared to monotherapy, this conclusion does not seem warranted. It appears that the lithium in the combination therapy was the key predictor of relapse while valproate was shown to have significantly worse outcomes than combination therapy or lithium alone. It seems clear that lithium was the key treatment option that accounted for the outcomes.
In the article by Rea et al., (2003), the investigators researched whether family therapy vs. individual therapy as an adjunctive treatment to medication had stronger effects. Subjects were 53 patients hospitalized in a manic state of bipolar disorder. They were randomly assigned to either individual therapy or psychoeducational family-focused therapy. Patients also received medication therapy. Follow-up evaluations occurred every three months for one year of active treatment and one year post-treatment. Results indicated that those receiving family therapy relapsed less and were less likely to need hospitalization across the two- year evaluation period compared to the individual therapy group.
It is extremely important to use the correct analysis for a research project because research questions can often only be analyzed using certain procedures. If the type of analysis is not correct the outcomes of the study will also be incorrect.
Reference
Geddes, J. R., Goodwin, G. M., Rendell, J., Azorin, J. M., Cipriani, A., Ostacher, M. J., & Juszczak, E.
(2010). Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet, 375(9712), 385-395.
Rea, M. M., Tompson, M. C., Miklowitz, D. J., Goldstein, M. J., Hwang, S., & Mintz, J. (2003). Family-
focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 71(3), 482.
