Partnerships and Connections

The UofL Depression Center is very involved in new studies and collaborations towards understanding depression and helping those suffering from the effects of depression. Learn more by visiting this blog and connecting with us on Twitter.

Computer-Assisted Therapy

A joint venture with the UofL Depression Center, the Department of Family and Geriatric Medicine and the Kent School of Social Work 

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- November 21, 2016

Can Technology Help Treat Depression?

This new study marks an important advance in CCBT research. Primary care patients from three clinics (two urban and one rural) associated with the Department of Family and Geriatric Medicine at the UofL are randomly assigned to receive CCBT or treatment as usual. The CCBT program includes use of a computer program (Good Days Ahead) specifically designed for treatment of depression in addition to weekly phone calls (for 12 weeks) from a therapy coach. The coach helps the patient apply cognitive-behavior therapy skills in everyday life.

Researchers from the UofL Depression Center are studying the effectiveness of computerassisted cognitive-behavior therapy in primary care patients with depression. The study is led by Dr. Jesse Wright, Director of the UofL Depression Center, who helped develop the computerized treatment program used in the research.

Previous research by Dr. Wright and his associates at the UofL and other universities has shown that computerassisted cognitive-behavior therapy (CCBT) is just as effective as standard cognitive-behavior therapy(CBT) despite reducing time with a therapist by up to two thirds.

The goals of CCBT are to:

  • make therapy more efficient (reduce reliance on long visits to a therapist)
  • lower the cost of treatment
  • provide broader access to effective therapy.

Earlier research that demonstrated effectiveness of CCBT was done in mental health settings.

This research is an example of collaborations that are promoted by the UofL Depression Center. Coinvestigators include Drs. Becky Antle and Lesley Harris from the Kent School of Social Work, Jason Wells and Renee Girdler

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Suicide Prevention

Bold Goals Against Suicide
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Zero Suicide Project
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Teachable Moment Brief Intervention
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Stephen O'Connor

Stephen O'Connor
Lead: Teachable Moment Brief Intervention

- May 23, 2017

"Zero Suicide Project"

- Partnership with Humana Bold Moves Against Suicide

The Zero Suicide project is coming to Louisville. Based on successful programs in other communities, such as initiatives at the Henry Ford Hospital system in Detroit, the Humana Bold Moves Against Suicide project is working with community partners, including the University of Louisville Depression Center, to use effective measures to save lives. Drs. O’Connor and Wright from the UofL Depression Center are leading the Zero Suicide project at the UofL and are working with others to coordinate a community-wide effort.

A Suicide Prevention Summit, held in November 2016, was successful in engaging a large number of organizations and helping participants learn key principles of suicide risk reduction. The Zero Suicide framework includes improvements in identifying and assessing suicidal individuals, providing evidence-supported treatments, ensuring smooth transitions of care, and improving data collection to promote quality improvements over time.

At the UofL Depression Center, Dr. O’Connor is collaborating with directors of inpatient units, Emergency Psychiatric Services, and consultation-liaison psychiatry to develop a systematic implementation of Zero Suicide methods. With funding from an anonymous donor, the Center will soon embark on a quality improvement initiative to make the Zero Suicide program a part of routine clinical care.

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New Drug Development

Ketamin: New Hope for Treatment Resistant Depression
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Hassan Khidr, MD, Psychiatry resident, and Rif El-Mallakh, MD , Professor, UofL Department of Psychiatry & Behavioral Sciences

- May 23, 2017

"Ketamine: New Hope for Treatment Resistant Depression"

Ketamine is a drug that was used in Vietnam War as an anesthetic. More recently, researchers have discovered that ketamine blocks a brain receptor called NMDA, part of the glutamate neurotransmitter system. This action is believed to be the origin of its antidepressant effect.

Although studies have found that ketamine has a dramatic and very rapid effect on reducing depressive symptoms, there are several problems with this drug, including the need to give it intravenously and a risk for causing hallucinations and other disturbances of perception. There has been a great increase in research on this drug because it may have unique potential for breakthroughs in treatment of depression.

Unlike other drugs for depression, ketamine works very quickly. But its positive effects usually disappear within 7-10 days. Thus, there are efforts underway to discover the exact mechanism of action of the drug and to develop similar medicines that can be taken orally, last longer, and don’t have the potential side effects of ketamine.

The most common side effects of ketamine are drowsiness, dizziness, poor coordination, blurred vision, and feeling strange or unreal. These side effects may happen in the first 4 hours after infusion but usually disappear afterwards. Other side effects include elevated heart rate and/or blood pressure. So, close supervision during ketamine administration is essential. Also, there are concerns about this drug’s abuse potential. It is used by some people as a street drug (sometimes called “Special K”) to alter sensation and “get high.” Doses used for treatment of depression are substantially lower than the amounts used by drug abusers.

The UofL Department of Psychiatry is currently offering this novel treatment for patients who have been battling depression for many years and have not responded to many other treatments. It is given in an inpatient setting under the supervision of a licensed anesthesiologist.

Researchers are working on ways to reduce the side effects and abuse potential of ketamine or ketamine-like medications and lengthen the time of response. A recent investigation published in Nature identified a specific metabolite of ketamine that is responsible for its robust antidepressant effect without the side effects of the parent com-pound. However, this isolated metabolite is not yet available for use in humans.

MORe Program

Mood Outcomes Registry (MORe program) has goal of instituting measurement-based care for all patients with depression and bipolar disorder.

UofL in association withNNDC

 

MORe Program

- September 21, 2016

Measurement-Enhanced Care Works!

Evidence continues to mount that measurement-enhanced care improves outcome of treatment of depression. A study from Beijing, China found that measurement-enhanced care more than doubled the rate of remission. And a recent review by Dr. John Fortney and associates in the journal Psychiatric Services concluded that measurement-enhanced care leads to robust improvements beyond those achieved with routine care for depression.

What is measurement-enhanced care? The key ele-ments of measurement-enhanced care are: 1) use of standard self-rating scales at each clinic visit; 2) results of the rating scales are provided to clinicians and patients at each session; 3) results are used to make decisions on treatment. Although the three steps in measurement-enhanced care are straight-forward, they are not taken in most clinical settings. Many reasons for not using meas-urement-enhanced care have been given: “It would take too much time….We don’t have the system to get the rat-ings done….It wouldn’t make a difference, so why go to the effort.”

Now that research has debunked the myth that measure-ment-enhanced care isn’t worth the effort, the UofL Depression Center taking action to adopt this form of care as standard practice. Supported by a gift from an anonymous donor, the UofL Depression Center is part-nering with the National Network of De-pression Centers (NNDC) to establish a digital system for patients to complete four standard rating scales (measuring depression, anxiety, manic symptoms, and suicidal thinking) on IPads prior to each clinic visit. The results are immediately available to clinicians and patients at the start of the treat-ment session.

Experiences with measurement-enhanced care at the UofL Depression Center have been highly favorable. Typically cli-nicians and patients view the symptom ratings at the begin-ning of each session. If good progress has been made, the treatment plan is probably on target. But if progress is stalled or other concerns are revealed, problems are addressed so the patient can get on a positive track to recovery.

The NNDC sponsored measurement-enhanced care initiative has over 2,500 patients enrolled to date. Over the next two years, the goal is to have at least 20,000 patients in the USA benefitting from this measurement-enhanced care system. As an early adopter of measurement-enhanced care, the UofL Depression Centers is helping lead the way in improving treat-ment for mood disorders.

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