Internet intervention improves self-, clinician-rated depression symptoms

TORONTO — When added to usual care, an internet-based intervention demonstrated effectiveness comparable to pharmacologic and psychotherapeutic treatments for depression, according to data from a randomized controlled trial.

“There is a huge treatment gap in depression; many patients who are depressed don’t get treatment, or don’t get adequate treatment,” Jan Philipp Klein, MD, of the department of psychiatry and psychotherapy at Lübeck University in Germany, told Healio.com/Psychiatry.

A number of available evidence-based internet interventions have shown effectiveness in reducing depression, he added. However, the caveat is that most of these interventions were proven effective in small sample sizes, and none included patients with clinician-rated disease.

With this in mind, Klein and colleagues developed the EffectiVeness of Internet-based DEpressioN Treatment (EVIDENT) trial, in which 1,013 patients with mild to moderate depressive symptoms were randomly assigned to usual care plus a 12-week internet intervention (n = 509) or usual care alone (n = 504). One third of patients included in the trial had diagnosed depression. The study was funded by the Federal Ministry of Health in Germany.

The intervention, according to Klein, “conveys cognitive behavioral therapy-based information on dealing with depression in an interactivemanner” by providing information on cognitive work, behavioral techniques, as well as mindfulness or acceptance techniques. Patients can then provide feedback on how they reacted to the information, which the intervention then uses to tailor future material.

The primary outcome was self-rated depression using the Patient Health Questionnaire: PHQ-9; depression and symptomatology were rated by physicians using the Hamilton Depression Rating Scale (HDRS-24) and served as the secondary outcome.

Results demonstrated that both groups improved; however, the intervention group experienced greater improvements in the primary outcome. According to Klein, there was also a small to medium effect on clinician-rated depression, quality of life, mental health quality of life and other measures of psychological functioning.

Moreover, the intervention was superior to usual care in inducing response, “which is fairly good compared with other treatments for depression,” Klein said.

“The real next step is integrating these treatments into actual clinical practice and actual care because we really have a large evidence base now and we are the first ones to also show that this evidence extends to clinician ratings of depression,” he said. “Really, what’s at stake now is implementing this into clinical practice.” – by Stacey L. Adams

Disclosure: Klein reports no relevant financial disclosures.

Reference:

Klein JP, et al. #P3-032. Presented at: American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto.