online treatment

Depression as a serious debilitating illness and not a weakness. Many patients don’t get adequate treatment for depression. What to do about this?

“the Internet affords the opportunity to make psychosocial interventions available to large segments of the public. Interventions can be delivered programmatically and reliably, greatly extending the numbers and types of people who can be reached with services”. In recent years, Web-based approaches have been increasingly used and it has been repeatedly shown that Internet-delivered treatments may be an effective and inexpensive alternative to traditional treatments. Most of the existing Internet-based depression treatments are based on cognitive-behavioral principles, although other modalities, such as problem-solving therapy, appear promising as well.

In Germany they developed Deprexis a novel, integrative program that could be delivered via the Internet to reduce symptoms of depression. Recently a paper is published describing an initial study of its effectiveness: Effectiveness of a Novel Integrative Online Treatment for Depression (Deprexis): Randomized Controlled Trial.

This web-based intervention was effective in reducing symptoms of depression and in improving social functioning. Findings suggest that the program could serve as an adjunctive or stand-alone treatment tool for patients suffering from symptoms of depression.

How was this study done?

There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Completer analyzes and intention-to-treat analyzes were performed.

Limitations
The researchers used a weighted randomization, participants were recruited via advertisements, the diagnosis of depression was not verified, between one-third and half of the sample was lost from the study at each time-point. They had to preform a lot of statistics tricks to analyze the data. The last observation carried forward, to my opinion the only right analyzes (LOCF) in which those who were lost to follow up on the first assessment after randomization were considered as non responders revealed that the efficacy of the online treatment was less pronounced. It was statistical significant difference of 3 points on the beck depression inventory but is that also clinically significant. Not according to my standards and not others view on this point

Following the recommendations of Seggar, Lambert, and Hasen, reliable change was defined as a move of at least 8.46 points on the Beck Depression Inventory (BDI) from pre-test to post-test (ie, from T0 to T1).

Dr Shock’s conclusion
Online treatments do have advantages such as easy access and that’s why I like these developments, this program looks promising but needs to be investigated in more homogeneous samples with clear diagnosis and less drop out. What do you think?

Björn Meyer PhD, Thomas Berger DPhil, Franz Caspar, DPhil, Christopher G Beevers, PhD, Gerhard Andersson, PhD, & Mario Weiss, MD, MBA (2009). Effectiveness of a Novel Integrative Online Treatment for Depression (Deprexis): Randomized Controlled Trial J Med Internet Res , 11 (2)