Remote Talk Therapy for Depression
Every year, 9.5 percent of the population, or about 18.8 million American adults, suffer from a depressive illness. Medication and psychotherapy, or the two in combination, have been shown to improve symptoms of ]]>depression]]> . However, both treatment methods remain underused. Medication side effects and the inconvenience of in-office psychotherapy may be partially to blame. And with both treatments, patients have to confront the stigma associated with depression, and they may feel their privacy is at risk.
According to a new study published in the latest issue of the Journal of the American Medical Association , psychotherapy by telephone― in addition to an antidepressant regimen― may have fewer drawbacks than traditional in-person counseling, and may be just as effective.
About the Study
Researchers in Seattle compared three antidepressant treatment methods: antidepressant medication alone, antidepressant medication with telephone care management (which addressed medication-taking issues), and anti-depressant medication with telephone care management and telephone psychotherapy (a maximum of eight, 30-40 minute sessions).
Researchers enrolled 600 Washington-state primary care patients who were just initiating treatment for depression (average age was 45). Patients were assigned randomly to one of the three treatment groups and followed for six months for signs of improvement.
Compared to medication alone, the group who received care management and psychotherapy by phone scored the lowest on a severity scale for depression. Eighty percent of this group also reported that their depression was “much improved,” in comparison to 55% of those who received medication alone, and 59% of them said they were “very satisfied” with their depression treatment as compared to 29% of those who received medication alone. The group who received medication plus telephone care management but no telephone psychotherapy also faired better than the medication alone group, but not as significantly.
How Does This Affect You?
These findings suggest that the widespread assumption that effective psychotherapy must be given in person ought to be reconsidered. Phone therapy could be particularly beneficial to patients living in rural settings, for example, who may be less motivated to seek in-person therapy due to limited access and small-town privacy concerns.
Some questions, however, were left unanswered by the study. Was it the psychotherapy itself that contributed to patients' improvement or was it simply the fact that patients in this group received additional attention? Or, did the phone therapy only serve to encourage patients to take their medication more consistently?
Furthermore, while phone therapy did appear to enhance the effectiveness of anti-depressant medication, the study did not address the most practical question of all: how does remote therapy stack up against face-to-face therapy? While it is still too early for psychiatrists to trade in their couches, effective treatment for depression may, one day, be just a phone call away.
National Institute of Mental Health (NIMH)
National Mental Health Association (NMHA)
Simon GE, Ludman EJ, Tutty S, Operskalski B, Von Korff M. Telephone Psychotherapy and Telephone Care Managament for Primary Care Patients Starting Antidepressant Treatment. JAMA. 2004; 298(8): 935-942.
Last reviewed Aug 27, 2004 by ]]>Richard Glickman-Simon, MD]]>
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