Center for Depression Research and Clinical Care
Few medical researchers have unlocked the mystery of how mental health conditions like depression affect the human brain—and how that should inform treatment.
That is why Madhukar Trivedi, M.D., and his team at the Center for Depression Research and Clinical Care (CDRC) are working to transform the way we identify and treat depression on an individualized basis. Dr. Trivedi is the Chief of the Division of Mood Disorders at UT Southwestern Medical Center and became the Founding Director of the CDRC in 2015, thanks to a generous gift from the Hersh Foundation. He has been a leading expert on mood disorders across Texas and nationwide during his nearly 30 years at UT Southwestern. In the last 5 years, he has also added resilience to his area of expertise, asking the questions that have rarely been asked in a research lab.
Early Identification & Resilience
The mental health of youth and teenagers is a public health priority worldwide and in our own community. Suicide is the second-leading cause of death among people ages 10 to 34, according to the National Institute of Mental Health. Depression and anxiety rates are also on the rise among adolescents across the country.
According to Dr. Trivedi, people tend to wait until a crisis occurs to address mental health issues like depression and suicide. That can leave people without access to quality mental health care for years. In fact, Dr. Trivedi says that in the U.S. there is about a 10 to 12-year gap between when somebody has their first symptoms of depression and when they receive a diagnosis.
“We wait for someone to get into trouble, have a crisis, and then say maybe they have a mental health issue,” Dr. Trivedi says. “We do not do this for any other medical condition. We don’t wait for someone to develop a stroke before we say, ‘Oh, maybe they have hypertension.’”
Early intervention is a top priority in the CDRC’s work because research shows that the average onset age of depression is between 11 to 14 years. Dr. Trivedi’s approach to identifying the symptoms early is two-fold: 1) Mental health education programming, and 2) Universal screening for depression.
Unlike most researchers, who do their work in the lab, Dr. Trivedi has taken an innovative approach to doing research in the community through partnerships. Since 2016, the CDRC has implemented a comprehensive mental health training program in North Texas middle and high schools.
Through the Youth Aware of Mental Health (YAM) program, the CDRC has connected thousands of students to mental health resources, equipping the next generation with the tools to cope with potentially self-destructive behaviors and develop emotional intelligence. The interactive program melds various learning techniques in order to build discussion and knowledge about mental health, suicide prevention, and problem-solving skills.
So far, YAM training has been provided for more than 10,000 North Texas middle school and high school students in 27 schools, from Fort Worth to Bonham. Based on study results, the YAM program has been more effective than the other programs in significantly improving adolescent mental health. It was associated with significant reductions in incident suicide attempts and severe suicidal ideation when compared to the other interventions.
“Since many people with depression have their first episode in their teens, it robs them of their potential,” Dr. Trivedi said. “We’re aiming to stop the disease in its tracks through our research, while also giving students the coping skills to better handle stress with resilience.”
Measurement-Based Care through VitalSign6
Universal depression screening is another solution that Dr. Trivedi sees for addressing the treatment gap and growing rates of depression. When people see their doctor for a routine check-up, a depression screening should be a regular part of that visit, Dr. Trivedi believes. Medical practice guidelines recommend universal screening for depression in primary care settings, yet treatment outcomes suffer with no model to manage those who screen positive for depression.
The CDRC has developed and shared a tool called VitalSign6 with dozens of physicians’ offices, health clinics, and schools in North Texas. VitalSign⁶ is a user-friendly app that helps physicians proactively and routinely monitor for depression during check-ups. More than 65,000 people have been screened using VitalSign6, and physicians who utilize the program receive support from CDRC specialists to help with treatment or further exploration for patients who present symptoms.
“This program creates an avenue for triaging patients to the right specialist at the right time,” said Dr. Trivedi. “If you look at 100 people with depression in the United States, only about six percent will get into full remission. We’re getting reports of 30 to 40% remission rates in different practices utilizing VitalSign⁶.”
These relationships with local providers make up the CDRC’s Mood Disorders Network, which aims to increase access to and improve the quality of mental health care across Texas.
Cutting-Edge Research and Prediction
Anyone who has lived with depression knows the struggle of getting connected to the right treatment. For years, mental health providers have relied on a trial-and-error approach to matching patients with the right therapy, medication, or combination of the two.
That is why the CDRC is working to develop predictive analytics with large-scale data to establish methods to match patients with the treatment.
“We know that when people have depression, bipolar disorder, or even those who are at risk – there is a brain dysfunction,” said Dr. Trivedi. “It is our job to really begin to understand where in the brain the dysfunction is, and what are the blood and brain tests we can do to diagnose patients with depression very early?”
These goals are becoming reality through the Texas Resilience Against Depression (T-RAD) Study. Through this 10-year study of 5,000 people, Dr. Trivedi’s team is collecting genetic, clinical, demographic, behavioral, and biological information from individuals at risk and those who have been diagnosed with depression or bipolar disorder. Research participants engage in a host of measures – from Magnetic Resonance Imaging (MRI) and electroencephalograms (EEGs), to blood draws, cognitive tests, and mental health assessments. All of these data will help unveil how to match individuals with the right treatment for them.
“There’s a profound amount of stigma and lack of knowledge about depression and suicide,” Dr. Trivedi said. “The more we can do to study it and make it more objective and scientific, the more these issues will be recognized and treated when they arise.”
The T-RAD study consists of two cohorts: 2,500 participants with depression or bipolar disorder, and 2,500 participants who are at risk but do not have depression, and therefore fall into the resilience cohort. The study has one site in Dallas and one in Fort Worth.
Among the CDRC’s other current studies are treatment-development research, examining the use of ketamine, esketamine, and transcranial magnetic stimulation (TMS) in treating depression. Other groundbreaking research findings from the CDRC include:
AI, brain scans may alter how doctors treat depression: Computer predicts patient outcomes based on EEG
AI helps scientists predict depression outcomes: Studies show brain activity patterns influence effect of antidepressants
On the Horizon
While Dr. Trivedi has already shifted the paradigm of how to understand and treat depression, he knows there is still more work to be done. The CDRC team has plans to further explore the link between depression and inflammation by examining the levels of C-Reactive Protein (CRP), Interleukin 17A (IL-17), Platelet-derived growth factor (PDGF) in people who are depressed. A growing team of neuroimaging experts within the CDRC is also working to better understand the effects of mood disorders and certain treatments on the structure and function of the brain.
“Without our dedicated research participants, we cannot advance the field. We cannot find new diagnoses. We cannot find new treatments. We cannot understand the disease and improve the lives and health of people,” Dr. Trivedi said.
The new Center, led by Dr. Madhukar Trivedi, Professor of Psychiatry and Chief of the Division of Mood Disorders at UT Southwestern, will take a comprehensive approach to:
Detecting illness at an earlier and more treatable stage through the study of biomarkers, treatment options, and delivery methods;
Developing a more scientific method for personalized treatment, directing patients quickly to the best portfolio of treatment; and
Providing leading-edge care for treatment-resistant mood disorders.
“The possibilities for significant advances in the understanding of depression and bipolar disorders have never been greater,” said Dr. Daniel K. Podolsky, President of UT Southwestern. “UT Southwestern’s rich research environment has paved the way for important discoveries. The Hersh Foundation’s generous gift supports the next important step − finding the biological foundations that can help us design more effective diagnoses and treatments tailored to an individual’s needs,” added Dr. Podolsky, who holds the Philip O'Bryan Montgomery, Jr., M.D. Distinguished Presidential Chair in Academic Administration, and the Doris and Bryan Wildenthal Distinguished Chair in Medical Science.
Founded in 1997 by Julie and Ken Hersh, the Hersh Foundation promotes mental health and cultivates future leaders through investments in organizations primed to create quantum-shift change. Julie Hersh, President of the Hersh Foundation, boldly detailed her struggles with depression in her book, Struck By Living: From Depression to Hope, and became a national advocate to highlight the need to better understand depression. She published her insights in the Journal of Medical Ethics and is an active member of the Patient Advisory Council for the International Society of ECT and Neurostimulation.
“Today, most people wait for a ‘Stage IV’ level of symptoms before seeking treatment for mental illness,” said Mrs. Hersh, a board member of Southwestern Medical Foundation and numerous other Dallas institutions, who also served on the advisory board to develop the Center. “Just as with breast cancer, most mental illness caught in an early phase and with the right treatment applied can be managed. Late reaction results in massive collateral damage – problems at work, familial strife, and even suicide. Dr. Trivedi and UT Southwestern are uniquely qualified to craft a more scientific approach for early detection and personalized treatment.”
The Center’s vision is to eliminate the devastating effects of depression on millions of lives by replacing the current trial-and-error treatment approach with the use of personalized medicine.
“There is an urgent need to identify brain, blood, and behavior-based diagnostic tests in order to improve early recognition,” said Dr. Trivedi, who holds the Betty Jo Hay Distinguished Chair in Mental Health. Dr. Trivedi received the 2015 American Psychiatric Association Award for Research, the Association’s most significant award for research.
According to Dr. Trivedi, the resulting tests could then be used to drive precision medicine for these conditions. Initially, clinical data will be collected from 2,000 individuals receiving treatment to identify biosignatures that can help predict outcomes.
As one of the landmark projects of the Center, Dr. Trivedi also will initiate a project that will follow teens and young adults through high school, when they are most vulnerable, to identify mood management issues.
UT Southwestern researchers have successfully demonstrated the impact of therapies beyond medication, including exercise, psychotherapy, and brain stimulation. In addition, the Center will focus on the impact of depression on the recovery from other diseases, such as cancer, cardiac disease, and diabetes. The Center will capitalize on the need for a comprehensive approach that is focused on achieving sustained wellness.
The Center combines basic research, translational clinical research in genetics, functional brain imaging, and treatment research across the entire age span, with a special focus on treatment of resistant, chronic, or recurrent depressions – the most disabling form of the disorder.
“The Center will be built on the principles of scientific rigor, interdisciplinary collaboration, and open innovation, which already define UT Southwestern’s biomedical research and clinical programs,” Dr. Trivedi said. “With support from the Hersh Foundation, we can advance the frontiers of mood disorders research, swiftly translating scientific discovery into clinical practice, and soundly restoring the full resilience of living to those on the cusp of losing hope. I am particularly indebted to Julie Hersh for her amazing advocacy and unwavering support for the creation of this Center.”
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. The faculty of more than 2,700 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year.
- Mental Health Research and Mental Illness Prevention Programs