Long Term Depression Eased By Phone-Based Therapy

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Long Term Depression Eased By Phone-Based Therapy

http://www.medicalnewstoday.com/medicalnews.php?newsid=65950

When people receive brief telephone-based psychotherapy soon after

starting on antidepressant medication, strong positive effects may

continue 18 months after their first session. So concludes a Group

Health study in the April Journal of Consulting and Clinical

Psychology.

This paper describes one more year of follow-up since a 2004 Journal

of the American Medical Association (JAMA) report on the same random

sample of Group Health patients.

" With close to 400 patients, this is the largest study yet of

psychotherapy delivered over the telephone, " said Evette J. Ludman,

PhD, senior research associate, Group Health Center for Health

Studies, the paper's lead author. " It's also the first to study the

effectiveness of combining phone-based therapy with antidepressant

drug treatment as provided in everyday medical practice. "

Long-term positive effects of initially adding phone-based therapy

included improvements in patients' symptoms of depression and

satisfaction with their care, said Ludman. At 18 months, 77 percent

of those who got phone-based therapy (but only 63 percent of those

receiving regular care) reported their depression was " much "

or " very much " improved. Those who received phone-based therapy were

slightly better at taking their antidepressant medication as

recommended, but that did not account for most of their improvement.

And effects were stronger for patients with moderate to severe

depression than for those with mild depression.

" We were surprised at how well the positive effects were maintained

over time, " said Ludman. " As with weight control, maintaining

improvement is the hardest part of treating depression. "

As is usual in clinical practice, the patients' primary care doctors

diagnosed their depression and prescribed their antidepressants.

Half of the patients also received eight sessions of telephone

psychotherapy during the first six months, then two to

four " booster " sessions in the second six months as well as

medication follow-up and support from masters-level therapists.

The patients and therapists never met face to face, only over the

phone, said Ludman. Patients weren't always easy to reach by phone,

and the therapists worked hard to reach them all. Therapists

followed a structured protocol for psychotherapy. They encouraged

the patients to identify and counter their negative thoughts

(cognitive behavioral therapy), pursue activities they had enjoyed

in the past (behavioral activation), and develop a plan to care for

themselves.

" The patients participated more fully in psychotherapy and completed

more sessions than do most depressed people in the community, " said

Ludman. Nationally, only about half of insured patients receiving

depression treatment make any psychotherapy visit, and less than a

third make four or more visits. By contrast, in this study, three in

four patients completed at least six phone therapy sessions. This is

striking, she added, because the study did not include people who

were already in counseling or planning to be.

" Giving psychotherapy to people with depression who were not seeking

therapy may help them significantly, " said Ludman. Depression

symptoms, including feeling discouraged and avoiding other people,

can prevent people from seeking help. One in four depressed people

who make appointments for in-person therapy are no-shows. " They slip

through the cracks, " she added.

Few of the patients who received phone-based therapy - even fewer

than those who did not receive it - sought in-person therapy. " This

suggests the phone-based therapy met their needs, without whetting

their appetite for more, " said Ludman. Phone-based therapy is more

convenient and acceptable to patients than in-person psychotherapy,

she said.

Next, Ludman said, the researchers plan to explore the combination

treatment's cost-effectiveness and impact on work and home life.

They also want to compare the effectiveness of phone-based treatment

with that of in-person visits.

The National Institute of Mental Health funded the study. The other

authors are Greg E. Simon, MD, MPH, and Von Korff, ScD,

senior investigators at Group Health Center for Health Studies; and

Steve Tutty, MA, now a doctoral student in clinical psychology at

Brigham Young University in Provo, Utah.