Dr. Madhukar Trivedi: The Depression Initiative
March 8, 2018
Professor of Psychiatry
For many, depression is a topic that carries with it a general sense of unease. But for Dr. Madhukar Trivedi that feeling of discomfort is not directed at the relatively taboo nature of the disorder itself; instead, it’s derived from immense dissatisfaction with how the medical world has treated and evaluated this common and often deadly condition.
About one in six people is susceptible to developing a mood disorder or has a personal connection to someone who will, Dr. Trivedi notes. Yet, he says, there’s a severe lack of objectivity in how patients are currently evaluated. There’s no standardized, methodical approach for diagnosing and treating these disorders, and because of this, patients who are fortunate enough to recognize their symptoms and receive treatment are often left with therapies that have little to no effect on their unique condition. It’s a problem that Dr. Trivedi and other doctors from renowned medical institutions around the country have made it their duty to solve. Their collective goal: reform clinical practice to bring about better diagnostic procedures, treatment options, and prevention efforts.
“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. Trivedi and his team at the Peter O’Donnell Jr. Brain Institute are the coordinating investigators for the National Institute of Mental Health-funded study called EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care), which is using 300 patient volunteers to evaluate a number of biological markers that researchers hope will help improve the efficiency and accuracy of mood disorder diagnosis.
The establishment of the biomarkers will also help shorten the path to recovery by allowing physicians to readily match patients with treatments that best fit their unique biological signature. Past approaches for mood disorder treatment widely involved prescribing singular therapies for patients, but recent research has shown that depression and other mood disorders come in varying degrees and types. Based on this new information, Dr. Trivedi and his team have taken on two major initiatives under the EMBARC banner to improve our understanding of depression and other mood disorders.
Their first initiative focuses on gathering information for the improvement of detection and evaluation efforts. To do this, Dr. Trivedi and his team are working to identify volunteers for the D2K (Dallas 2000) study, which will follow 2,000 patients with depression for 20 years. It’s an approach patterned after the Framingham Heart Study, a long-term evaluation of cardiac disease patients that altered and greatly improved the therapeutic approach to heart disease. A long-term study like this has never before been conducted for depression.
The second initiative revolves around prevention. For Dr. Trivedi and his team, it’s not enough to simply be able to identify and treat depression and other mood disorders; there needs to be equal attention paid to discovering ways for people to improve their resilience before symptoms arise. Dr. Trivedi and his team have partnered with local area Uplift high schools to provide incoming freshmen with mental health fitness and awareness programs designed to improve students’ knowledge of common mood disorders and help them practice ways that will help strengthen their mental well-being.
“We’ve advanced the idea that measurement of depression is one of the most important things patients can do to both inform themselves, keep engaged, and also demand the best treatments from providers.”
Vital Sign 6
An integral piece to realizing the goal of these ambitious studies is Vital Sign 6 — a mobile application developed by Dr. Trivedi and his team to help primary care physicians prescreen patients for mood disorder symptoms, regardless of their reason for the visit. This is essential because many people suffering from mood disorders don’t speak up about it unless prompted, and as a result, the average duration between having symptoms and first diagnosis is often 10 to 12 years.
The software app uses data to craft specific questions designed to improve the accuracy of mood disorder diagnosis and also help physicians monitor and track their patients so they receive the proper treatment when appropriate. Patients simply fill out the questionnaire at their primary care physician’s office, thus making screening for depression the sixth vital sign after body temperature, pulse rate, respiration rate, blood pressure, and pain.
“About 30 percent of patients with depression will have their first episode of it before the age of 18.”
The Uplift Education program is a public charter school network in North Texas that provides free, college-preparatory education in communities that have limited high-quality public education options. About five years ago, the school system noticed a need for greater mental health guidance for their students and, in response, they developed a new Social Counseling Program with 30 licensed mental health professionals on staff to provide direct mental health services.
Their most recent undertaking involves partnering with Dr. Trivedi and his Youth Aware of Mental Health Program to teach incoming freshmen about mental health and social/emotional wellness and well-being. The school system tracks student psychosocial data using 28 different metrics to help determine when and where the program is needed most — a unique exercise not used by any other school district or network. With this program, school officials are hoping to groom new generations of students to not only have an extensive knowledge of common mood disorders but also to take proactive steps toward evaluating their own well-being and that of others.
“There’s no reason for a patient with depression to feel like there’s no hope. That’s something we have to change. We have to make this a real focus of the next 10 years.”
Great advances have been made in the realm of depression and mood disorder research. It’s no question that Dr. Trivedi and his team’s role in the EMBARC initiative has been pivotal to breaking modern stigmas and establishing new protocols essential for improving the lives of those battling these misunderstood disorders.
The focus of Dr. Trivedi and his team now is ensuring the sustainability of their studies over the next couple of decades. The results garnered from the studies will revolutionize the current procedural practices for mood disorder treatment and prevention efforts, but it’s not just research volunteers they need to realize this future. With your help, they can continue to sustain their important work and ensure a better future for patients with depression and other mood disorders.