Depression

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

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.

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.