Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

Abstract

Background: Strategies to improve the life of patients suffering from recurrent major depression have a high relevance. This study examined the efficacy of 2 Internet-delivered augmentation strategies that aim to prolong symptom-free intervals. Methods: Efficacy was tested in a 3-arm, multicenter, open-label, evaluator-blind, randomized controlled trial. Upon discharge from inpatient mental health care, 232 adults with 3 or more major depressive episodes were randomized to 1 of 2 intervention groups (SUMMIT or SUMMIT-PERSON) or to treatment as usual (TAU) alone. Over 12 months, participants in both intervention arms received, in addition to TAU, intense monitoring via e-mail or a smartphone, including signaling of upcoming crises, assistance with personal crisis management, and facilitation of early intervention. SUMMIT-PERSON additionally offered regular expert chats. The primary outcome was ‘well weeks', i.e. weeks with at most mild symptoms assessed by the Longitudinal Interval Follow-Up Evaluation, during 24 months after the index treatment. Results: SUMMIT compared to TAU reduced the time with an unwell status (OR 0.48; 95% CI 0.23-0.98) through faster transitions from unwell to well (OR 1.44; 95% CI 0.83-2.50) and slower transitions from well to unwell (OR 0.69; 95% CI 0.44-1.09). Contrary to the hypothesis, SUMMIT-PERSON was not superior to either SUMMIT (OR 0.77; 95% CI 0.38-1.56) or TAU (OR 0.62; 95% CI 0.31-1.24). The efficacy of SUMMIT was strongest 8 months after the intervention. Conclusions: The fully automated Internet-delivered augmentation strategy SUMMIT has the potential to improve TAU by reducing the lifelong burden of patients with recurrent depression. The fact that the effects wear off suggests a time-unlimited extension.

Effectiveness of a tailored, integrative Internet intervention (deprexis) for depression: Updated meta-analysis

“…Additionally, this meta-analysis found that larger effects were only observed for MoodGYM in studies that involved face-to-face guidance, whereas effects were small (g = 0.23, NNT = 7.7) when remote guidance by telephone or email was provided, and there was no evidence to suggest that the programme was effective without any guidance. However, guidance does not always enhance the effects of Internet interventions, as several trials have not found larger effects when guidance was provided, and a meta-analysis suggested that the effects of guidance may be less pronounced than often assumed [34][35][36]. In our meta-analysis, the effect sizes for deprexis were in the clinically relevant range regardless of whether no guidance or some guidance was provided.…”

Two-Year Follow-Up after Treatment with the Cognitive Behavioral Analysis System of Psychotherapy versus Supportive Psychotherapy for Early-Onset Chronic Depression

“…These comprise integrative care approaches organized in disease management programs and long-term support with low-threshold therapeutic contacts. For example, a fully automated internet-delivered augmentation strategy (SUMMIT) was superior to treatment as usual in patients with recurrent depression over 24 months after discharge [45]. …”

Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial

“…The effectiveness of Internet interventions in routine clinical settings has recently been questioned as one study failed to demonstrate the superiority of two Internet interventions with telephone guidance over usual care in participants with at least moderate depressive symptoms recruited through their general practitioners [14]. Another recent study has demonstrated the efficacy of an Internet intervention following inpatient treatment [15]. …”