Cognitive- behavioural therapy (CBT) is an augmentation strategy used in bipolar depression because it improves compliance to treatment, patient's insight into specific areas of daily behavior, allows patient to recognize early signs of disease and to cope with stressfull events.

To analyse the efficacy and action onset of augmentation cognitive- behavioural specific techniques in patients diagnosed with bipolar depression that receive an antidepressant and anticonvulsant combination therapy.

A group of 18 patients, 6 male and 12 female, mean age 32.9, admitted in our clinic with bipolar disorder type I, major depressive episode (DSM-IV-TR) were distributed in two equally groups, one of them received only antidepressant drug plus anticonvulsant, the other combined psychopharmacological treatment with CBT. All patients received carbamazepine (flexible dose 400-600 mg/day) and selective serotonin reuptake inhibitor (SSRI): 7 patients fluoxetine 20-40 mg/day, 6 patients paroxetine 20-40 mg/day and 5 sertraline 150-200 mg/day. Inclusion criteria: Hamilton Depression Rating Scale 17 items (HAMD-17) over 17, Young Mania Rating Scale (YMRS) under 10. Exclusion criteria: axis I or II comorbidity. We used weekly for 4 weeks and monthly for 5 months HAMD, YMRS, Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI).

There was a significant better improvement in patients receiving CBT treatment (-12%HAMD, -14%GAF, -16%CGI). YMRS was stable in both groups. The onset of antidepressant action was observed earlier in CBT group (10.5 days compared to 17.5).

CBT stands as an efficacious augmentation strategy for patients who are treated with antidepressant and anticonvulsant therapy.