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05-03-2015 | Multiple sclerosis | Article

Online CBT may relieve depression in multiple sclerosis patients

medwireNews: An online cognitive behavioural therapy (CBT) programme may help patients with multiple sclerosis (MS) who are experiencing depression, research suggests.

The randomised study used the online CBT-based programme Deprexis, which has previously proved effective in depressed patients without major medical comorbidities.

“In view of the motor impairment and fatigability typically associated with multiple sclerosis, as well as the limited availability of psychotherapists, self-guided, automated, internet-based interventions such as Deprexis might be particularly useful for patients with multiple sclerosis and a need for depression treatment, at least as an interim solution until psychotherapy is available”, say Stefan Gold (University Hospital Hamburg-Eppendorf, Germany) and study co-authors.

The programme consists of 10 modules, each of which can be completed in less than 60 minutes, allowing patients with fatigue or cognitive impairments to undertake treatment at a time and pace that suits them.

As reported in The Lancet Psychiatry, 35 MS patients with self-reported depression were assigned to the Deprexis group and remained in the study until the 9-week follow-up point, spending an average of 5.5 hours using the programme.

During this time, their average score on the Beck Depression Inventory (BDI) fell from 19.44 to 16.24, which was a significant improvement relative to the score of a control group of 36 patients assigned to a waiting list, which worsened slightly from 18.40 to 19.51. The proportion of patients above the cutoff for clinical depression (BDI 13) decreased significantly, from 69% to 54%, in the Deprexis group, but increased slightly, from 67% to 69%, in the control group.

Patients in the Deprexis group had significant improvements relative to controls for BDI negative attitude towards self and for BDI somatic symptoms, and a nonsignificant improvement for BDI performance impairment.

Most patients in the Deprexis group said that the programme “met or exceeded their expectations”, and many would recommend it, although 51% felt it may need to be tailored to the specific needs of MS patients.

When reassessed after a further 6 months, patients in the Deprexis group had significantly reduced BDI scores relative to at baseline, at 14.8.

In an accompanying commentary, Christian Otte (Charité Universitätsmedizin Berlin, Germany) calls the results “encouraging”, but suggests that adding clinician contact to the programme might deliver additional benefits, as well as providing a means of managing crisis situations such as suicidality.

“Online CBT is probably best used in stepped-care models of depression treatment”, he says. “In these models, interaction with a psychotherapist and pharmacotherapy can be added in case [internet] CBT as a first step of treatment does not elicit a sufficient treatment response.”

By Eleanor McDermid

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