Transforming Bipolar Disorder Research and Care
Bipolar disorder is a serious mental health condition that affects more than 40 million people worldwide. While bipolar disorder research has historically been underfunded, three family philanthropies recently announced they are donating $150 million to launch a new initiative known as BD2: Breakthrough Discoveries for Thriving with Bipolar Disorder. Serving as chair for the Scientific Steering Committee for the Integrated Network, the Brigham’s Katherine Burdick, PhD, will play a central role in the program’s efforts to break down barriers between innovation, scientific findings and clinical care for bipolar disorder.
Burdick, the vice chair for Research in the Department of Psychiatry and director of the Mood and Psychosis Research Program at the Brigham, recently sat down with us to answer questions about bipolar disorder and BD2.
Q: Bipolar disorder is often dramatically depicted in the media, ultimately creating negative stigmas for people with the disorder. What is a common misconception that many people in society may have about this illness?
KB: In general, mental illness is often misattributed to a personality flaw, a weakness of the mind or lack of sufficient willpower—which are complete misunderstandings of what causes psychiatric symptoms and contribute to ongoing stigma. We know, with ample scientific data to support this, that bipolar disorder is a medical condition. This can and should be conceptualized in the same way people think about cancer or diabetes. In the case of bipolar disorder, anomalies in perception, thought, motivation, mood and behavior are driven by abnormal neurobiological processes. With appropriate treatment and management, people with bipolar disorder can live full and very satisfying lives.
Q: What makes the BD2 initiative particularly unique and exciting?
KB: Because bipolar disorder is complex, highly heterogenous and dynamic, relatively slow progress has been made toward understanding the specific behavioral and biological mechanisms that contribute to risk for the onset and recurrence of the illness. BD2 is comprised of four interconnected initiatives: Discovery Grants, Brain Omics, Genetics Platform and the Integrated Network—all of which are designed to share data, methods and resources across programs and with the broader bipolar community. Collaboration and open science are key tenets of the initiative.
I serve as chair for the Scientific Steering Committee for the Integrated Network, a prospective, longitudinal study of 4,000 patients diagnosed with bipolar type I who will be followed annually for at least five years. BD2 is the first initiative in the field that provides sufficient funding and resources to allow for a study like this to be conducted at the necessary scale and scope to address the complexity of the disease.
Additionally, this longitudinal study will be conducted upon a platform of a learning health network where data come not only from the research protocol but are also generated at the point of care – in the clinic – through close collaborations between clinicians, researchers, patients, and caregivers. This model provides a unique opportunity to accelerate the translation of research discoveries to improvements in clinical care.
Q: What are some of the challenges of carrying out long-term studies on those with bipolar disorder, and how do you plan to tackle them?
KB: Recruitment and retention are difficult with longitudinal studies. We have designed BD2 to optimize patient participation. In addition to contributing their “data,” participants will also help us co-design and build the learning health network for their clinical care. As part of BD2’s development over the past 18 months, we have interviewed patients with bipolar disorder and directly asked them what they most want to get out of participation in a project like this one. Consistently, they’ve voiced the desire to know more about themselves by accessing the data we are collecting. By meaningfully engaging patients in the process and providing them with data and feedback on how they are doing, we expect patients will enjoy participating and gain clear benefits in how they view their disease and the care they are receiving. We see the enrollment of the Integrated Network cohort as the building of a community—one where patients, researchers, clinicians and caregivers will bond over the common goal of optimizing outcomes and advancing research and care in bipolar disorder. This is a unique aspect of BD2.
Q: How can BD2 work collaboratively with biomedical companies to reignite concern within this area?
KB: BD2 is using a multi-pronged approach across basic, translational and clinical research studies to learn more about the mechanisms that drive the disease. In this way, we fully anticipate data derived from each component of this initiative will provide new insights into the pathophysiology of the disease and its associated outcomes. This will give the entire field—pharma companies included—novel treatment targets (molecular, genetic, circuit-based or behavioral). By working in parallel across platforms, BD2 can quickly translate basic science findings into clinical insights. The Integrated Network protocol is designed as a platform upon which we can rapidly build ‘sub-studies’ to follow up on new discoveries, which will likely include clinical trials as well as other innovative investigations. We fully anticipate future collaborations and partnerships with federal agencies, other foundations and industry to expand upon the existing BD2 foundation.
Q: Do you see this potentially opening the door for a global network intent on tackling this mental health disorder?
KB: Absolutely. In fact, this has truly already been an international effort. We held multiple scientific planning committee meetings over the past 18 months under the leadership of the Milken team, with nearly 100 scientific and clinical experts from across the globe contributing to the design of BD2. This collaborative approach, in combination with direct feedback from patients with bipolar disorder, will ensure the product is a protocol optimized for international participation. Although the initial six sites for the Integrated Network component will take place in the United States, we will open the call for applications from international sites in Year 2. The Integrated Network seeks to scale up over three years to achieve a global reach and a broad diversity of sites and participants.