Psychiatrist Returns to Sunnybrook To Tackle Bipolar Disorder in Youth

By Jim Oldfield

It took a compelling opportunity to lure Dr. Ben Goldstein back to Sunnybrook Health Sciences Centre. Until 2009, he was settled into a faculty position and a productive lab studying bipolar disorder--a condition of radical mood swings--in children and adolescents at the University of Pittsburgh Medical Center.

But having done his medical residency at Sunnybrook under the mentorship of Dr. Anthony Levitt, Psychiatrist-in-Chief and a professor at the University of Toronto, Goldstein knew Sunnybrook's department of Psychiatry to be collegial--a huge draw.

Moreover, in his new role at Sunnybrook, 20 percent of Goldstein's time will focus on clinical work in the department of Psychiatry's youth division, which is the largest in the country, while 80 percent will be protected for research in the Brain Sciences Program. Although he expects the hours spent with patients to creep up as he builds a practice, the dedicated time for research is critical, says Goldstein.

"When you start your own lab, it's so easy to lose momentum. If you don't have protected time for grant writing, and access to research staff and resources, you can't get forward traction."

Goldstein has secured a grant from the Ministry of Health and Long-Term Care to monitor and study risk factors for heart disease in adolescents with bipolar disorder. Adults with bipolar disorder are at least twice as likely to die of heart disease than those without it, and on average 15 to 25 years earlier than adults in the general population.

"In adolescents, studies have shown that adherence to guidelines from professional associations like the ADA [American Diabetes Association] is low," says Goldstein. "So one thing we can do is watch to see that their weight and blood pressure aren't getting out of control."

As well, mapping the biology underlying the link between heart disease and bipolar disorder early--which for as many as two-thirds of patients means during adolescence, when the illness first arises--would further help physicians identify those most at risk. This would enable intervention at a stage when the condition is more malleable. A potential biological marker of the connection between heart disease and bipolar disorder is inflammation, and Goldstein will be pursuing that link in studies over the next couple of years.

Goldstein's long-term goal is to do the Toronto 1,000, a large-scale study of adolescents with and without bipolar disorder that would stretch over two decades.

While researchers have made great strides in identifying adolescent bipolar disorder, Goldstein says there's still much work to do.

"I'd like to see a future where there are medications that aren't such a burden on the body," he says. "There are whole classes of drugs, like anti-inflammatories, that have yet to be tried and that could be effective from a mind and body perspective. But we need research to prove which are best."