In hopes of revealing the root causes of bipolar disorder and tailoring treatments, psychiatrists at Johns Hopkins have begun asking patients about sharing data with large multicenter research collaborations.
“Understanding what causes bipolar disorder is really challenging,” says psychiatrist David Bond, who directs an outpatient clinic for patients at The Johns Hopkins Hospital. “It’s a combination of genetics, environmental factors, and chance — which then influence brain structure and function. The field is coming to realize that to study these complex and interacting factors, we need large samples of people from whom we can gather high-quality data.”
The team already has been part of a large mood disorders registry as part of the National Network of Depression Centers, says psychiatrist Fernando Goes, who directs an outpatient clinic for mood disorders at Johns Hopkins Bayview Medical Center and the Precision Medicine Center of Excellence in Mood Disorders. That group has accumulated information on several thousand patients.
Now, Johns Hopkins investigators aim to share information with an initiative titled “BD2 - Breakthrough Discoveries for thriving with Bipolar Disorder,” which will launch this spring. Supported by $150 million in philanthropic donations from the founders of various leading tech companies and supported by economic thinktank the Milken Institute, the organization is creating a multicenter study that has the potential to transform traditional understanding of bipolar disorder, its causes, and why different people experience varied treatment responses. “An especially exciting aspect of the study,” says Bond, “is that it could function as a network that will translate research discoveries into improvements in clinical care in near-real time.”
Johns Hopkins will be one of several national and international sites that will enroll 4,000 people with bipolar disorder to create a learning health care system (LHS) focused on improving the care of individuals with bipolar disorder. The LHS will gather patients’ sociodemographic information, such as age and gender, as well as illness-related information, such as symptoms and frequency of depressive and manic episodes, Bond says. They also will collect blood samples for genetic analysis and brain images. “We’re hoping to combine all of those things to show how genetic factors and environmental factors contribute to the brain changes that cause bipolar disorder and the types of symptoms people experience,” he says.
Such studies could lead to identification of features or subtypes of the disorder that could help clinicians predict who is likely to respond better to specific treatments, or could help them develop treatments targeted toward specific biological causes, Bond and Goes say. “The hope is that this is integrated so it becomes a lifelong means of improving clinical care,” says Goes. “Bipolar disorder is a lifelong illness, so you need lifelong study that is easy to engage in and can help patients and their clinicians better understand their illness in real time.”
A new clinic at Johns Hopkins, which focuses exclusively on bipolar disorder, provides expertise, new and established treatments, as well as other potential emerging tools such as wearables, sleep monitoring and pharmacogenetic testing for patients as needed.
Bond came to Johns Hopkins last August from the University of Minnesota, where he was an associate professor of psychiatry and director of the university’s Early-Stage Mood Disorders Program. His research interests lie in identifying biological and clinical factors to enable early, accurate diagnosis of bipolar disorder, and investigating the interface between bipolar disorder and cardiovascular risk factors such as obesity and cigarette smoking, and whether these factors predict a more severe form of bipolar disorder.
To learn more about the BD2 initiative, visit bipolardiscoveries.org.