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AN UPDATE ON BIPOLAR DISORDER: EVIDENCE, CHALLENGES, AND SOLUTIONS

Andrew Nierenberg — Massachusetts General Hospital

2026 ASCP Annual Meeting

Despite best practices, bipolar disorder continues to be a challenge to get our patients to recover from an acute mood episode and then keep them well. Guideline-informed treatment, while reasonable, may be difficult for clinicians to implement. Furthermore, there is a notable lack of data demonstrating that guideline-informed treatment yields better outcomes. Part of the challenge of guideline-informed care is that it is derived from narrow RCTs and usually does not apply to people with complex patterns of multiple comorbid conditions. Additionally, while evidence-based psychotherapy for bipolar disorder improves outcomes, it can be difficult for patients to access. This presentation will review the current state of evidence for treating people with bipolar disorder (with the caveats above) and discuss progress in developing the Bipolar Action Network. The network aims to utilize data from clinical encounters and the collective wisdom of clinicians to continually learn and improve outcomes.

Learning Objective 1: Analyze the limitations of current guideline-informed treatments for bipolar disorder—including challenges in implementation, restricted generalizability of RCTderived recommendations, and barriers to accessing evidence-based psychotherapy—and evaluate how these limitations contribute to persistent difficulties in achieving and sustaining recovery.

Learning Objective 2: Describe the goals and emerging structure of the Bipolar Action Network and explain how leveraging real-world clinical data and clinician expertise within a learning health system can promote continuous improvement and better outcomes for individuals across the spectrum of bipolar disorder.

References

  1. Nierenberg AA, Margolis P, Strakowski S, Trivedi M, Yatham LN. A Bipolar Learning Health Network: An innovation whose time has come. Bipolar Disord. May 2023;25(3):177180.
  2. Nierenberg AA, Agustini B, Kohler-Forsberg O, et al. Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA. Oct 10 2023;330(14):1370-1380. doi:10.1001/jama.2023.18588