Some say that Texas is the land of big ideas, and there’s one doctor at UT Southwestern Medical Center who’s proving that to be true in the field of mental health.
If you hear about a major effort in our city related to mental health detection, treatment, or prevention – chances are good that Dr. Madhukar Trivedi is aware of it and supporting it in some way. As Director of the Center for Depression Research and Clinical Care (CDRC), Dr. Trivedi believes deeply in the importance of better understanding the mysteries of the brain.
“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? Currently, we wait until somebody is in a crisis, and if you look at patients in this country there is about a 10 to 12-year gap between when somebody has their first symptoms and when they’re diagnosed.”
Dr. Trivedi is leading a tide shift in North Texas when it comes to early detection of mood disorders. But why is early detection so important? Research shows that untreated mental illness significantly scars the hippocampus, the area that is involved in emotions. “The volume is reduced so that it’s almost like the brain shrinks, which is a negative consequence of not being treated,” said Dr. Trivedi. “That becomes harder to reverse when you do get treatment. I don’t think we have this kind of debate for people with diabetes, hypertension, or breast cancer. Depression is another medical illness like any of them, and just purely for medical reasons we should diagnose illness as soon as it appears, and not wait.”
“This program creates an avenue for triaging patients to the right specialist at the right time. 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. Some practices follow the protocol and evidence-based treatment exactly, and their remission rates can be as high as 50 or 60 percent.”
Dr. Madhukar Trivedi, Director of the Center for Depression Research and Clinical Care
The Center for Depression Research and Clinical Care is approaching mental health in our community proactively. Instead of waiting for patients to come to the academic center to get diagnosed or treated, they are going into the community to provide screenings. They are currently engaged with 20 schools and 21 primary and pediatric practices in North Texas.
One of the key programs backed by Dr. Trivedi’s research is VitalSign6, a user-friendly app that helps community physicians proactively and routinely monitor for depression during check-ups. More than 45,000 people have been screened using VitalSign6, and physicians who utilize the program receive support from CDRC specialists when it comes time to recommend 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. Some practices follow the protocol and evidence-based treatment exactly, and their remission rates can be as high as 50 or 60 percent.”
For concerned parents, Dr. Trivedi offers words of encouragement. “If a child, especially a teen, has depression and you treat it appropriately – it doesn’t always have to be medication,” he said. “There are lots of treatment options, including exercise regimens, psychotherapy, and some medications. They will return to their previous level of functioning. Their relationships will be fine, and they will lead a normal life. They may need treatment again in the future, which is something that will need to be observed.”
“One size fits all does not apply. We have to become more individualized, and I think that the technology development combined with the programs and research we are conducting are reaching a pitch where we can get there.”
Dr. Trivedi also stresses that it’s important to note anti-depression medicines are not addictive. They treat a condition, and can be stopped when needed. They require monitoring and there may be some withdrawal symptoms – but that is not the same as addiction.
Above all, Dr. Trivedi is a champion for individualized care. “One size fits all does not apply,” he said. “We have to become more individualized, and I think that the technology development combined with the programs and research we are conducting are reaching a pitch where we can get there.”
“And yet, the only way to totally transform the way we deal with depression, a comprehensive, ambitious, sustained research focus is sorely needed. Our Center has, therefore, launched two large “Framingham Heart Study” type of initiatives – the D2K and RAD studies whose major goal is to develop blood and brain tests so that in the future, depression is addressed like any other medical illness and we can move to precision medicine for our patients.”