UT Southwestern investigators test depression research in real-world setting

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UT Southwestern investigators test depression research in real-world

setting

Media Contact: LaKisha Ladson

lakisha.ladson@...

DALLAS – June 12, 2008 – UT Southwestern Medical Center psychiatry

researchers have taken what they learned from their groundbreaking

research on treating depression and are applying it to real-world

clinical settings.

The Sequenced Treatment Alternatives to Relieve Depression

(STAR*D) study was the largest ever on the treatment of major depressive

disorder and is considered a benchmark in the field of depression

research. The six-year, $33 million study initially included more than

4,000 patients from clinics across the country.

STAR*D provided evidence for step-by-step guidelines to

address treatment-resistant depression and found that half of depressed

patients became symptom-free or had major improvement after the first

two treatments with medication.

Based on those findings, Dr. Madhukar Trivedi, professor of psychiatry

at UT Southwestern and a leader of the STAR*D study, developed a

computerized treatment system and is now testing it in a Nashville,

Tenn.-based mental and behavioral health care organization.

“This is exciting because although this project incorporates elements of

STAR*D and cutting-edge algorithms developed and refined by UT

Southwestern researchers over decades, it moves way beyond that,” said

Dr. Trivedi.

The computer software provides a step-by-step guide to assist doctors as

they’re treating patients. For example, the program prompts physicians

with more specific questions that go beyond “Do you feel better?” after

taking medication.

“This computerized system gives doctors assistance at the time that

they are seeing the patient,” Dr. Trivedi said. “It's like walking with

someone learning to ride a bike versus just sitting there and telling

them how to ride.”

The administration of depression treatment is often inadequate, Dr.

Trivedi said.

“Major depressive disorder treatment lags behind the care

of other chronic diseases,” said Dr. Trivedi. “It’s not like an

infection where you treat for a short time and that’s it.”

Doctors often don’t ask follow-up questions of their patients, and they

certainly do not routinely use systematic measurement tools to gauge

progress, he said.

“My interest is in helping clinicians, researchers and patients in

real-practice settings,” Dr. Trivedi said. “It’s a different magnitude

of complexity when you go to a busy clinical practice setting away from

academic centers.”

In the STAR*D project, also led by Dr. A. Rush, professor of

clinical sciences and psychiatry at UT Southwestern, only about 50

depression patients from each test-site clinic were selected to participate.

“Studying depression in a very small setting with an isolated patient

population was important as we sought to answer certain essential

questions, but it is different from the regular practice of doctors and

patients,” Dr. Trivedi said.

In the current research project, all patients with depression at study

sites will be included. The number of patients could reach 8,000,

depending on how many are scheduled for treatment with Centerstone, a

nonprofit provider of community-based behavioral health services that

has partnered with Dr. Trivedi. Centerstone operates facilities in

middle Tennessee and southern Indiana.

“Previous research has pulled out a few drops of water from a pond,

whereas now we are looking at the whole pond and all its possible

murkiness,” Dr. Trivedi said.

Centerstone facilities were chosen in part because of their cohesiveness

and technological capabilities.

“We know depression is similar to other chronic illnesses

and yet treatable. We know we have a lot of options,” Dr. Trivedi said.

“While we are still developing other treatment alternatives, it’s

important to make sure that the research we have now works in the real

world. This work with Centerstone will help ensure that depressed

patients receive the most effective treatment regime available.”

The work is funded by a $1.2 million grant over three years awarded by

the Agency for Health Care Research Quality for an information

technology initiative.

Visit http://www.utsouthwestern.org/mentalhealth to learn more about UT

Southwestern’s clinical services in psychiatry.

###

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