Making the Impossible Possible: The Challenges of Practicing Evidence-Based Psychiatry with a Focus on Bipolar Depression*

Andrew A. Nierenberg, M.D. - brain and behavior research expert on bipolar disorder
Andrew A. Nierenberg, M.D.

From The Quarterly, Winter 2014

The treatment of bipolar disorder, and especially bipolar depression, continues to challenge patients and doctors. Many people with bipolar depression experience difficult-to-treat, recurring depressive episodes.

In his talk, Dr. Nierenberg discussed the challenges clinicians face in treating bipolar depression, and how studies undertaken by his team have informed clinical practice.

Dr. Nierenberg and his colleagues have conducted clinical trials to determine the effects of short- and long-term treatments and what treatments appear to work best. He presented findings from some of the largest studies of bipolar disorder ever conducted: the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and the Lithium Moderate Dose Use Study (LiTMUS). STEP-BD results raised questions as to the efficacy of the use of antidepressants for bipolar depression while LiTMUS showed that low doses of lithium in addition to other medications do not appear to improve outcome.

Dr. Nierenberg also discussed a recently completed study, Bipolar CHOICE, that compares benefits and risks of lithium compared to quetiapine (Seroquel®), a secondgeneration mood-stabilizing antipsychotic. He not only reviewed the available evidence for treatments for bipolar depression, but also critiqued the structure of the evidence and the challenge of practicing and implementing evidence-based psychiatry.

Dr. Nierenberg earned his M.D. from the Albert Einstein College of Medicine of Yeshiva University and completed residency in psychiatry at New York University/ Bellevue Hospital. He studied clinical epidemiology at Yale University as a Robert Wood Johnson Clinical Scholar, then joined the faculty at Harvard Medical School, at McLean Hospital, before assuming his current posts.

Andrew A. Nierenberg, M.D.
Professor of Psychiatry
Harvard Medical School
Director, Bipolar Clinic and Research Program
Associate Director, Depression Clinical and Research Program
Massachusetts General Hospital
2013 Colvin Prize for Outstanding Achievement in Mood Disorders Research
Brain & Behavior Research Foundation Scientific Council Member
2002 NARSAD Independent Investigator Grant

*The 2013 Gloria Neidorf Memorial Lecture
The late Gloria Neidorf struggled with and succumbed to bipolar disorder in 1989. Her family established the Gloria Neidorf Memorial Lecture in hopes to inspire and educate others.