— During the last three decades, we have witnessed dramatic improvements in both the psychosocial and pharmacological treatments of affective disorders. Administered in concert with the new medications advances in pharmacology have produced, disorder-specific psychosocial treatments have further improved the prognosis and course of bipolar and unipolar disorder. Methods — We review our research on unipolar and bipolar disorder and their treatment, in particular interpersonal psychotherapy (IPT) and modifications thereof. Results — We provide empirical evidence that IPT is an efficacious acute and maintenance treatment for affective disorders. Our cumulative research and clinical experience suggest that interpersonal relations and circadian and social rhythms influence affective illnesses and that psychotherapy may aid in normalizing problems in these areas for patients with affective illnesses. Conclusions — Despite the excitement generated by the recent progress in research on mental disorders and their treatment, we are yet to fulfill the promise that the explosion of knowledge about targeted pharmacotherapies or psychotherapies would seem to offer. To move our field forward, we must continue to apply scientific rigor and thought to understanding the suitability of current nomenclatures, the impact of comorbid psychiatric and medical illnesses and symptoms on the manifestation and treatment of affective disorders, and the practicality of widespread utilization of new treatments.

Interpersonal therapy (IPT) was developed in the late 1960s, but has only recently gained real prominence. The interest in this approach has grown further following the positive findings obtained in the NIMH study (Elkin et al., 1989). In this extensive, multi-site US study it was found to be as effective as CBT and, in some methods of analyses, more effective. There is a growing literature on IPT's use with older people (Miller and Reynolds, 2002), but very few articles, with the exception of Bauer's (1997) work, have examined its use with people with cognitive impairment. The present paper describes the use of IPT to treat a man (Mr M) with dementia suffering from depression. The case is presented chiefly as a vehicle to explore the applicability of the conceptual framework, although details regarding treatment are discussed.

Over the last 40 years certain psychosocial treatments have made great strides on the long road towards becoming a reliable clinical science. A mark of this maturation is the recent enabling of sufferers from anxiety disorders and depression to help themselves when guided by particular manual or computer self-help systems, indicating that several effective therapeutic mechanisms have become reasonably defined. Still unknown, however, is exactly how many separate therapeutic paths are being trodden to improve anxiety and depression, and how much various tracks converge on common mechanisms. Careful dismantling studies may in time reveal that some behavioural, cognitive and interpersonal therapy procedures are in fact proxies for administering as yet dimly-perceived therapeutic principles. Progress would accelerate further once therapists were required to specify how much they improve their patients on simple and widely-agreed measures of outcome and cost, and once they learn to speak a broad-accepted common language.