Remarks y The majority of people living with bipolar disorder would benefit from maintenance treatment used in the absence of acute symptoms to preserve stability of clinical symptoms and avoid acuity of symptoms, recurrence or relapse. y In the majority of studies included in the evidence, psychosocial interventions were used adjunctively to medicine, but given the recommendation for psychotropic medicine use for six months, it is still good for psychotherapy to be provided to those not on medicines as well. y Moderate evidence indicates that psychotherapy is effective in the prevention of relapse and low-quality evidence indicates that it lowers the severity of depressive symptoms (but not mania symptoms). y There is relative difficulty in providing psychological interventions in LMICs whereas medicine is preferred due to ease and low costs. This is something that needs to be overcome and is also reflected in the lack of research.

Implementation considerations y Persons with bipolar disorders, similar to all serviceusers, should be treated with respect and dignity, and provided care based on their consent, in line with human rights instruments, without coercion. y Attempts should be made to involve families and carers in the treatment. Family psychoeducation, a relatively simple intervention that has been proven effective, should be offered in all settings. y Not all forms of psychological interventions may be available in LMICs. Differences in availability and accessibility to mental health system infrastructure and resources should be considered. y Variations in cultural context should be considered that may have implications on treatment acceptability. y Country adaptation and translation of training materials and tools for the provision of psychological interventions is essential. y Face-to-face psychological interventions delivered by service providers are human resource-intensive as they require substantial provider time, training and supervision. y Integrating the provision of psychological interventions into primary care provides many advantages, including more holistic health care, increased accessibility of mental health services for people in need of care, opportunities for reducing the stigma of mental health problems and reduced costs.