Dr. Andrew Nierenberg
By Emalee Gillis, NAMI Spokane Blog Editor.
The presentation through NAMI Ask the Expert that focused on the latest advancements in research and treatment for bipolar disorder that aired last month held surprising results. The first surprise was that the presenter, Dr. Andrew Nierenberg, an international expert on the illness who has published almost 600 scholarly articles, said if there was only one thing to take away from his session it was to “listen to your mother.”
He explained that research has shown that some of the most effective approaches to stabilizing people with bipolar disorder are things that we hear from our mothers, including go outside and play with your friends. Research has shown that exercise, time outside, and connections with other people do help people stabilize. Mothers also tell us not to do drugs or if you have to drink alcohol, do so modestly. Research has verified that drugs (including marijuana) and alcohol are risk factors for developing hallucinations and delusions.
Dr. Nierenberg added that our mothers also said to get a good night’s sleep which is really important for people with bipolar disorder. He also noted that mothers tell their kids to brush their teeth and it turns out there’s a dental-mental connection and that gum disease may actually cause brain inflammation.
The second most important thing that Dr. Nierenberg wanted participants to take from his presentation was the availability of a resource that helps patients and families to understand the different evidence-based treatments available for bipolar disorder. This is a Canadian publication, but he recommends it to people in the US. The Patient and Family Guide to the CANMAT and ISBD Guidelines on the Management of Bipolar Disorder is available here.
One of the most exciting aspects of Dr. Nierenberg’s presentation was the work related to genetics and bipolar disorder. He explained that the genetics of bipolar disorder are complicated. It isn’t as simple as looking at one gene. Researchers are currently studying 22 different genes that are all involved with bipolar disorder. His hope is that understanding the genetics will lead to more effective medications and better outcomes.
More effective medications are needed because according to Dr. Nierenberg, the medications currently prescribed for bipolar disorder are only effective for about half the people prescribed them. That means that individuals with the disorder have to try multiple medications to find the one drug or combination of drugs that work for them. New knowledge of the genetics of the illness could allow doctors to target specific genes and increase the effectiveness of treatments.
Another surprising point made in the presentation was Dr. Nierenberg’s view that even though lithium has been around for a long time, he believes it is still the gold standard for bipolar medication. He noted that “it works better acutely for mania than depression, but it also helps people keep well over time. If people take it for decades, there is a small risk of kidney problems with it, and that’s what people worry about the most. So it’s not perfect, but we’ve had many decades of use and understand it in terms of its actual use.” Even though he believes that lithium is the gold standard, it is being prescribed less over time. In ’97-’98, about 30%-plus of people who had bipolar disorder were taking lithium but it has decreased over time to a current level of 15%. Dr. Nierenberg encouraged people with bipolar disorder who have never been prescribed lithium to discuss the possibility with their healthcare provider.
Dr. Nierenberg said that the current median number of medications prescribed for bipolar patients is three, however, although some research projects have studied the use of two medications, there are no studies on how three different medications work together. That means it is paramount for patients to track and communicate to their providers how well the combination is working for them to control symptoms as well as any side effects.
Many apps can help with tracking symptoms and side effects and many of them are free. According to Dr. Nieirenberg, “If you track carefully and systematically, it can help you and your treater share measurements together. If you share the measurements, you both know what’s going on and that can lead to shared decision-making, which I think is really optimal.”
Dr. Nierenberg also stressed that research evidence shows that there are numerous psychotherapies that are effective for bipolar disorder. Some of these evidenced-based approaches include: Cognitive Behavioral Therapy (CBT), Mindfulness-Based Cognitive Therapy (MBCT), Family Focused Therapy (FFT), Interpersonal Social Rhythm Therapy (IPSRT), Unified protocol for emotional regulation, and Dialectical Behavioral Therapy (DBT).
Books Dr. Nierenberg recommended related to these approaches include the Bipolar II Disorder Workbook: Managing Recurring Depression, Hypomania, and Anxiety by Noreen A. Reilly-Harrington, Louisa Grandin Sylvia, and Stephanie McMurrich Roberts; The Wellness Workbook for Bipolar Disorder: Your Guide to Getting Healthy and Improving Your Mood by Sylvia PhD and Louisa Grandin; and Mindfulness-Based Cognitive Therapy for Bipolar Disorder by Thilo Deckersbach, Britta Holzel, Lori Eisner, Sara Lazer, and Andrew Nierenberg.
Dr. Nierenberg concluded his presentation with looking at gaps in research. More research is need to explore comorbidity with bipolar disorder, treatment of young people with the disorder, integrating medical care with mental health care and team-based review of patients and their treatment.
To hear Dr. Nierenberg’s full presentation, click here.
Dr. Andrew Nierenberg is an international expert on bipolar disorder and the Director of the Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital. He is also a full professor at the Harvard Medical School and has published almost 600 articles.
Emalee Gillis is a writer and blog editor. She is the author of the memoir Adventures on the Path to Living Well with a Mental Illness and has a related TEDx Talk.