K. Eve Lewandowski, PhD, Pamela Mahon, PhD, and Robert Gonzalez, MD, discuss the scope and potential impact of a new national bipolar disorder study that includes Mass General Brigham hospitals, McLean Hospital and Brigham and Women’s Hospital, as a joint site.
Bipolar disorder is a mental health condition that can seriously affect a person’s mood, daily activities and cognition. BD2: Breakthrough Discoveries for Thriving with Bipolar Disorder is an initiative designed to expand knowledge and clinical care of bipolar disorder. BD2 recently announced that two Mass General Brigham member hospitals, Brigham and Women’s Hospital and McLean Hospital, were chosen to be one of the sites for the BD2 Integrated Network, which integrates clinical, behavioral, and biological data to gain new insight into bipolar disorder and accelerate improved treatment. Over the next five years, the BD2 Integrated Network will engage 4,000 people living with bipolar disorder as part of a longitudinal cohort study. To maximize the impact and speed with which insights can be leveraged to improve care, BD2 will also develop a Learning Health Network — a community of clinicians, researchers and patients that is designed to rapidly identify and endorse effective care practices. Clinical and biological data collected across sites will be shared through a centralized data system so researchers can collaborate on research and improve understanding of bipolar disorder, which could lead to more personalized treatments.
Three investigators from across Mass General Brigham will help lead efforts at the Boston-based joint site. Principal investigator for the Brigham-McLean site K. Eve Lewandowski, PhD, director of Clinical Programming at McLean OnTrackTM, research team lead Pamela Mahon, PhD, associate vice chair for Research in the Brigham’s Department of Psychiatry, and clinical team lead Robert Gonzalez, MD, director of the Mood Disorder Clinic in the Brigham’s Department of Psychiatry, recently sat down with us to answer questions about bipolar disorder and the new joint BD2 site.
Q: What is the current state of bipolar disorder research and care?
RG: Up to this point, research focusing on the underlying mechanisms of bipolar disorder has been underfunded when compared to other psychiatric conditions like major depression or schizophrenia. The structure of this initiative will allow us to define unique clinical signatures of bipolar disorder. For instance, we have very little understanding of whether bipolar depression is the same as unipolar depression and so treatments for the condition have been lacking.
Q: How can the BD2 initiative help address some of these challenges?
EL: One of the exciting aspects about the BD2 initiative is the structure of the Integrated Network. We will have a dual framework that allows us to collect deep data from our participants and simultaneously access information from the Learning Health Network to address the needs of our patients. It’s an innovative way to translate research data into clinical practice and then use what we learn to create more knowledge.
PM: Also, bipolar disorder is a very complex disorder characterized by the course of illness. Having a detailed longitudinal study across five years allows us to collect information that will help us gain insights about the course of disorder and help people experience better outcomes through integration with the Learning Health Network.
Q: How does the joint site between the Brigham and Women's and McLean draw on the strengths of both hospitals?
PM: Our hospitals are both part of the Mass General Brigham healthcare system, which enables us to collaborate effectively. Each hospital also serves different local communities, so being able to work together allows us to include individuals living with bipolar disorder across the broader Boston area.
EL: Clinics and providers have their own unique characteristics, so a bipolar clinic here may not look like a bipolar clinic elsewhere in the country. By integrating across the Brigham and McLean, and with our other partners across the BD2 network, we’re going to learn not just about participants, but also about care providers and clinics, and that will help us better understand what works and for whom and in what context.
Q: What does having a site here in Boston mean for patients in New England?
RG: The BD2 project is unique in that it is strongly focused on collaborative care. For example, we’re building a dashboard that can track information like patient mood state and symptoms, that will give patients a greater understanding of their evaluations.
PM: We have been doing research for a long time in the Boston area, and we have a vibrant community of participants who are very committed to understanding and improving bipolar disorder treatment. This is an opportunity for individuals to be a part of the leading edge of developing new and effective evidence-based care.
Q: What does it take to engage patients and ensure that they remain a part of a research study over the course of many years?
PM: We're interested in engaging with people around how they can contribute to the research and how the research can contribute back to them. For example, gaining insight into their own disorder through the dashboard Dr. Gonzalez mentioned can be motivating for participants. Beyond that, it's about developing relationships with individuals with lived experience of bipolar disorder who are interested in helping us with the research.
Q: What are some newer treatment strategies being developed for bipolar disorder?
RG: The presentation of the illness can vary dramatically between patients diagnosed with bipolar disorder. Different physiological mechanisms may underlie these clinical differences and require different treatment interventions. The deep phenotyping and real-time information that the Learning Health Network provides will be a powerful approach for identifying targeted treatments for specific bipolar disorder subtypes.
EL: Absolutely. And I would add that it’s not just what works and for whom, but also when. Bipolar disorder often goes undiagnosed or improperly diagnosed for a long period of time. We have the chance, through this project, to get people connected to good care quickly, and see what treatments are most effective at different stages of illness. We see this as an opportunity to create targeted, personalized medicine for people living with bipolar disorder.
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