Revolutionizing Mental Health

UT Southwestern Medical Center’s Peter O’Donnell Jr. Brain Institute is making unprecedented strides in the way we understand the intricacies of the human brain. With multidisciplinary teams focused on more than 200 areas of specialty care, a wide variety of neurological illnesses and conditions are being investigated with an aim to build a better quality of life for patients and families across our region and beyond. The Center for Depression Research and Clinical Care (CDRC), which is part of the O’Donnell Brain Institute, continues to make transformative discoveries that are revolutionizing how we diagnose, treat, and prevent mental health and mood disorders.

“I can think of no one whose family or friends have not been touched in one way or another by brain-related illness. The goal of the Brain Institute is to find the causes and treatment of brain and spine diseases, and the means of preventing them. UT Southwestern is uniquely positioned to meet these challenges because of our remarkably talented researchers and clinicians.”

– Dr. Daniel K. Podolsky, President of UT Southwestern

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Innovation Rooted in Philanthropy

Through the Hersh Foundation, Julie and Ken Hersh gave a $5 million lead gift to establish the CDRC. This gift has propelled innovation forward, with an emphasis on early detection and treatment of depression and mood disorders.

Research shows that untreated mental illness significantly scars the hippocampus, the area that is involved in emotions. This scarring creates consequences that are harder to reverse as time goes on.

With support from our generous community, Dr. Madhukar Trivedi, M.D., is leading large, critical research studies, implementing early detection programs in schools and clinics across our region, and connecting health care providers with a support network that connects patients to the right resources. He is also leading social change by advocating for improved education around mental health.

Deepening our Understanding of Depression

Texas Resilience Against Depression (T-RAD), a study led by the CDRC, was developed to further understand biological mechanisms of depression, ultimately increasing the ability to practice effective prevention and improve overall treatment.

The 10-year longitudinal study is currently examining the clinical, behavioral, genetic, and brain imaging biomarkers for two different groups of participants; known as cohorts. The Depression cohort comprises 2,500 youth and adults with depression or bipolar disorder with the goal of improving treatment. The Resilience cohort includes 2,500 adolescents who are classified as at risk for depression or bipolar disorder, aimed at increased prevention.

A recent, groundbreaking finding from the study was published in a research manuscript in EClinicalMedicine, revealing that cerebral blood perfusion levels could serve as markers for depression treatment selection.

Early Detection and Diagnoses

VitalSign6, a web-based iPad application, is one piece of a comprehensive program meant to improve the process for identifying, screening, and treating depression. VitalSign6 began with the idea that mental health is a foundational aspect of overall wellness. Just like blood pressure and heart rate, the CDRC team has championed the notion that mental health should also be routinely measured and monitored, making it the sixth vital sign for which physicians screen. By supplying medical providers with an easy-to-use, efficient way to manage routine screenings of patients’ mental health, the program aims to implement the screening process as a scientifically validated, standard practice, and integrate clinical decision support.

Today, the profound impact of VitalSign6 has been felt in clinics in our community and beyond. VitalSign6 has been implemented in 27 Dallas-area clinics, with eight additional clinic launches in progress. The program also includes a teletherapy component, providing behavioral activation therapy already to over 340 patients. The program has also resulted in more than 66,000 screens of adult and pediatric patients. Of those, just under 20% have screened positive for depression.

The effect VitalSign6 has had on remission rates has proved even more profound. While remission rates in community samples are generally 6%, the remission rates with implementation of VitalSign6 is 35% after follow-up.

Recent media coverage of VitalSign6 has appeared in Annals of Family Medicine, on NPR, and in D CEO, bolstering education and messaging to the public.

Customized Treatment

Depression, along with a wide range of mood disorders, has often been addressed in the medical field without the ability to personalize approaches. The CDRC is transforming this idea of mental health solutions with the introduction of new methods to customize treatment for each individual patient to optimize its effectiveness.

“Depression is a brain disease to which we have not paid enough attention. It’s common. It can be measured. And it can be treated.”

– Dr. Madhukar Trivedi, M.D., Director of the Center for Depression Research and Clinical Care

Recently, new neuroimaging techniques are being utilized at the CDRC in order to identify moderators of treatment response and predict the outcomes of different antidepressant treatments. Electroencephalography, MRS, and fMRI are among some of the imaging technologies used to bring these findings to light and apply them to personalize the way patients are treated.

Additionally, the CDRC is in the process of developing a simple blood test with the power to inform depression diagnosis and treatment options based on each individual’s biological makeup.

The development of new techniques and methods with an emphasis on personalized care has the potential to increase the overall success rate in treating depression quickly and effectively. Furthermore, improving treatment efficacy may reduce the rate of hospital readmissions while decreasing the risk of other mental health-related side effects associated with depression.

Generating a Greater Awareness

In addition to increasing understanding so that health care professionals may better diagnose, treat, and prevent mental health disorders, the CDRC is promoting a greater understanding of what mental health is.

Through YAM, (Youth Aware of Mental Health) the CDRC has connected thousands of adolescents to mental health resources, equipping our next generation with the tools and mechanisms to cope with potentially self-destructive behaviors and develop emotional awareness and intelligence. The interactive program melds various learning techniques to foster 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.

Beyond training programs, the CDRC has brought its findings to a broader audience through its publications. In 2018, the CDRC team published 51 original manuscripts. This year, the CDRC is on target to exceed this number, with 44 articles published as of August 2019.

CDRC’s faculty and leadership has also gained more visibility, with Dr. Trivedi serving as the 2019 President of the American Society of Clinical Psychopharmacology (ASCP). Dr. Trivedi was also recently announced as the recipient of the American College of Psychiatrists 2019 Mood Disorders Reward.

“There’s a profound amount of stigma and lack of knowledge about depression. The more we can do to study it and make it more objective and scientific, the more mood disorders will be recognized and accepted.”

– Dr. Madhukar Trivedi

Continuing Progress

As the CDRC continues to generate transformative findings, the operation continues to expand. A new satellite research clinic in Fort Worth is in the early stages of launching, showing promise for elevated efforts across our region and ultimately across our nation.

“Supporting advances in identifying and treating mental illness is of paramount importance to improving our overall health care. The progress being made by the CDRC at UT Southwestern is yielding immeasurable benefits for this reason.”

– Kathleen M. Gibson, President and CEO of Southwestern Medical Foundation

While incredible progress has been made, there are more discoveries and breakthroughs ahead. With the continued support from our community, we are one step closer to solving the mysteries of the brain and bringing mental health to the forefront of patient care. The CDRC will continue to improve our region’s health care by bridging the gap between mental health diagnosis and the physicians, patients, and community members who can bring solutions. With each breakthrough from the CDRC comes the promise of greater understanding and better outcomes for a world we all wish to see.