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Depression

Mental health professionals at UT Southwestern Medical Center are leaders in research to provide evidence-based care for people with all types of mental health conditions. Our psychiatrists, psychologists, nurses, and other care providers have extensive expertise in treating people with depression, including severe and treatment-resistant forms.

Evidence-Based Treatment for Depression

Depression is a mood disorder that causes feelings of sadness or loss of interest as well as a variety of physical symptoms such as sleep or appetite problems. One of the most common mental disorders in the U.S., depression interferes with daily life and can persist for several weeks or longer.                                                                  

UT Southwestern’s ongoing care for people with depression combines diagnosis, evidence-based treatment, and inpatient and outpatient care options. Our psychiatrists, psychologists, and their teams evaluate patients and then provide a customized combination of therapy and medication to meet each patient’s specific needs.

We take a comprehensive approach to treatment using the latest therapies, which can include novel antidepressant medications as well as nutritional and behavioral approaches. Additional treatment options include psychotherapy, psychoanalysis, marriage and family counseling, exercise regimens, and brain-stimulation therapies for treatment-resistant depression.

UT Southwestern’s Center for Depression Research and Clinical Care (CDRC) conducts cutting-edge research to improve the treatment of depression and bipolar disorder. Through observational studies, clinical trials, and community partnerships, the CDRC aims to transform the diagnosis and treatment of mood disorders and revolutionize our understanding of their biological causes.

Types of Depression

The main types of depression include:

  • Major depressive disorder: Causes feelings of sadness, loss of interest, anger, or frustration that interfere with daily life for weeks or longer periods of time
  • Persistent depressive disorder (also known as dysthymia): A depressed mood that lasts at least two years, during which time patients can have episodes of major depression alternating with periods of milder symptoms
  • Postpartum depression: More severe than “baby blues,” which are mild feelings of depression and anxiety that usually go away within two weeks of having a baby, postpartum depression has symptoms of major depression and can interfere with a woman’s ability to take care of herself and her baby
  • Premenstrual dysphoric disorder: Affects women typically one week before their period and goes away after menstruation
  • Seasonal affective disorder: Depression that occurs during fall and winter and most likely results from a lack of sunlight
  • Major depression with psychotic features: Severe depression along with loss of touch with reality (psychosis); symptoms can include delusions (fixed false beliefs) or hallucinations (seeing or hearing things that others cannot)
  • Bipolar disorder (formerly called manic depression): Characterized by episodes of mood swings ranging from depressive lows to manic highs; although bipolar disorder has depression as one of its symptoms, it is a different type of mental illness, and treatment is usually lifelong

Causes and Risk Factors of Depression

It is not known exactly what causes depression, but medical experts believe that a combination of biological, psychological, environmental, and genetic factors are involved. These include:

  • Biological differences: People with depression appear to have physical changes in their brains.
  • Brain chemistry: Changes in naturally occurring brain chemicals known as neurotransmitters, and how they interact with neurocircuits involved in maintaining mood stability, might play a significant role in depression and its treatment.
  • Hormones: Changes in the body's balance of hormones might be involved in causing or triggering depression. Hormone changes can occur during pregnancy and in the weeks or months after delivery (postpartum). They can also result from thyroid problems, menopause, or other conditions.
  • Stressful situations or trauma: Events such as physical or sexual abuse, loss of a loved one, job loss, divorce, financial problems, or difficult relationships can cause or trigger depression.
  • Inherited traits: Depression is more common in people whose relatives also have the condition. Researchers believe that several genes are involved in causing depression.

Certain risk factors can increase the risk of developing or triggering depression, such as:

  • Alcohol or drug abuse
  • Medical conditions such as cancer, heart disease, or chronic pain
  • History of other mental health disorders such as anxiety or post-traumatic stress disorder
  • Social isolation
  • Medications such as certain antibiotics, heart or blood pressure pills, or sedatives

Symptoms of Depression

Depression can happen at any age and often begins in the teens, 20s, or 30s. In fact, the average age of onset is 11 to 14. Some symptoms vary depending on age, but they generally include:

  • Sad or irritable mood most of the time
  • Lack of interest or pleasure in activities usually enjoyed, such as hobbies or sex
  • Outbursts of anger or frustration, even over small matters
  • Lack of activity and avoiding usual activities
  • Difficulty sleeping or sleeping too much
  • Major appetite changes, often with weight gain or loss
  • Fatigue and lack of energy
  • Feelings of worthlessness, self-blame, and guilt
  • Feeling slowed down or restless
  • Difficulty concentrating or remembering things
  • Repeated thoughts of death or suicide

Watch Janice's Story

Imagine battling severe depression for decades with no treatment making a difference. That was the reality for 64-year-old Janice Blake. The loving grandmother says she even considered taking her own life until electroconvulsive therapy at UT Southwestern Medical Center saved it.

Diagnosing Depression

Our mental health professionals conduct a thorough evaluation, which might include a:

  • Physical exam
  • Patient Health Questionnaire (PHQ-9) screening
  • Review of personal and family medical history
  • Discussion of symptoms

At UT Southwestern, we also assess patients and monitor their progress using validated depression-measurement algorithms, many of which are not found in most community health settings. These tools allow us to evaluate patients with greater precision than typical subjective evaluation and include:

  • Psychiatric evaluation: Our mental health professionals ask patients about their thoughts, feelings, and behavior patterns using evidence-based questionnaires.
  • DSM-5: We use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to establish a diagnosis of depression.
  • Lab tests: Blood and urine tests measure levels of hormones and other substances in the blood to check for abnormalities that might show an underlying physical cause. These tests can also rule out other conditions with similar symptoms.
  • Genetic screening: We evaluate patients’ potential response to particular medications, which helps us determine the right medications and dosages for each individual.

Treatment for Depression

The CDRC at UT Southwestern provides detailed evaluation methodologies and comprehensive therapies for people with depression. Customized to the needs of each patient, treatment plans can incorporate:

  • Medication
  • Psychotherapy and psychoanalysis
  • Brain stimulation therapies such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) for severe and treatment-resistant depression
  • Exercise

We provide expert care in both outpatient and inpatient settings. Outpatient care provides ongoing services and support for people living with depression. Our inpatient program provides short-term care for people with severe or treatment-resistant depression who are in crisis.

Outpatient and Primary Care Services

Through our outpatient services, we help people with depression build their coping skills with therapies to minimize symptoms that might interfere with work, school, relationships, and other areas of life.

Our mental health care teams offer:

  • A wide variety of antidepressant medications
  • Individual, group, and family therapy using cognitive-behavioral, psychodynamic, and interpersonal techniques, among others
  • Psychoanalysis
  • Marriage, couple, and family counseling

We also guide and support patients in developing self-care habits such as exercising, eating healthy foods, and avoiding alcohol and drugs.

Growing national awareness of the importance of mental health to overall health has led to broad recognition of depression as the “sixth vital sign.” UT Southwestern uses VitalSigns6, an iPad-based approach to evaluating and treating depression, to help manage the condition for people who receive primary care within our growing network of providers.

Severe or Treatment-Resistant Depression Therapies

If medications, therapy, psychoanalysis, or a combination of these treatments do not relieve symptoms, we offer hope through specialized therapies for severe and treatment-resistant depression. We have particular expertise in brain stimulation therapies such as ECT and TMS and medications such as ketamine. 

Electroconvulsive Therapy (ECT)

ECT is a safe, effective procedure for severe depression that is performed while patients are asleep. The procedure delivers a small amount of electric current through the brain to impact the function and effect of neurotransmitters to relieve depression.

UT Southwestern is a leader in the use of ECT, performing this treatment more than other institution in Texas. We have been a key site for groundbreaking studies to evaluate ECT and are part of the Consortium for Research in ECT (CORE), a National Institute of Mental Health-funded study that includes only a handful of leading academic medical institutions nationwide.

We are experienced in providing ECT for patients with:

  • Major depressive episodes (unipolar and bipolar)
  • Manic or mixed episodes
  • Schizoaffective disorders
  • Rare cases of schizophrenia with prominent mood or catatonic features

Patients receive electrical stimulation as an outpatient procedure two to three times a week for several weeks. Our doctors and nurses closely monitor each patient to ensure safety and improve outcomes.

Transcranial Magnetic Stimulation (TMS)

TMS is a procedure that uses magnets precisely placed on the head to stimulate nerve cells in the brain that are involved in mood regulation and depression. During TMS, patients receive medication to help them relax, but they are awake.

Patients typically receive 30- to 45-minute treatments five times a week. TMS can provide significant improvement in patients for whom standard medications have not been effective.

The UT Southwestern team uses an array of algorithms to determine which patients are most likely to benefit from TMS and then to determine the optimal placement and amplitude of the procedure for each patient.

Ketamine and Esketamine

Ketamine is an anesthesia medication that is also dissociative, which means that it creates a sense of detachment. Recent studies suggest that the drug can provide quick-acting benefits for people with serious depression and suicidal thoughts. Ketamine is administered intravenously under close supervision.

Esketamine, a mirror molecule of ketamine, is an investigational, rapidly acting antidepressant that works differently than currently available therapies for major depressive disorder. Through glutamate receptor modulation, esketamine is thought to help restore connections between brain cells in people with treatment-resistant depression.

Clinical Trials

Discoveries that shed light on the underlying mechanisms of depression and investigations of new ways to evaluate and manage it are continually underway. As an academic medical center, UT Southwestern provides diagnostic and therapeutic strategies for depression that are not widely available.

Current clinical trials focus on various therapies, such as nasal ketamine, esketamine, isoflurane, and low-frequency magnetic stimulation.

In addition, UT Southwestern’s CDRC is conducting a long-term study called Dallas 2K, examining the biological mechanisms of depression and antidepressant treatment response. Researchers will collect socio-demographic, clinical, and biological data of 2,000 participants with a mood disorder diagnosis. With this information, we hope to create a biosignature to aid in treatment selection and to identify a universal test for diagnosing depression.

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Behavioral Health

at UT Southwestern Medical Center at Richardson/Plano 3030 Waterview Parkway, 1st Floor
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