Phone Therapy Helps Treat Depression

Telephone psychotherapy works as adjunct to antidepressants, study finds

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HealthDay Reporter

TUESDAY, Aug. 24, 2004 (HealthDayNews) -- A little bit of psychotherapy on the phone can be a powerful addition to antidepressants for reducing the symptoms of depression, new research shows.

The large-scale study in the state of Washington found that 55 percent of people reported their symptoms were "much improved" after they started taking antidepressant medication. But when eight sessions of telephone therapy were added, 80 percent reported feeling significantly better.

"We don't think that the telephone is somehow better than traditional psychotherapy," said study author Dr. Gregory Simon, a psychiatrist and mental health researcher at Group Health Cooperative in Seattle. "In fact, in-person is probably more powerful. But this outreach was to people who wouldn't come in otherwise, and the telephone therapy got dramatically better results than for those who received no therapy."

However, while both psychotherapy and antidepressant medications can be effective for treating depression, few people stick with them long-term.

According to the study, about 40 percent of people taking antidepressants stop taking them during their first month of therapy. Only one-third of people with depression ever seek psychotherapy and only half of those who do attend more than four sessions. About one-quarter stop going after one session, the study findings showed.

"We were interested in finding ways to improve care for people who were getting prescriptions for antidepressants from their family care doctor," Simon said.

The study results appear in the Aug. 25 issue of the Journal of the American Medical Association.

Six hundred people who were just starting antidepressant medications were recruited for the study. Their average age was 44, and three-quarters were female.

The participants were randomly assigned to one of three groups. The first group received standard care from their primary-care physician; the second group received standard care plus telephone care management; and the third group received a combination of standard care, phone care management and phone psychotherapy.

Phone care management included three outreach calls from case managers, who asked the study volunteers about their depressive symptoms, if they were taking the medications, and if they had experienced any adverse side effects. The case managers then reported their findings to the treating physician.

Telephone psychotherapy included eight sessions of structured cognitive-behavioral psychotherapy. Each session lasted 30 to 40 minutes. If an individual wasn't available for a therapy session, the therapist kept calling until contact was made.

Eighty percent of the people who received all three treatment options reported their symptoms were "much improved" after six months, compared to 66 percent of those who got phone management, and 55 percent of those on medication alone.

Fifty nine percent of those receiving phone therapy said they were very satisfied with their depression treatment, compared to 29 percent for the medication-only group and 47 percent for the phone management group.

One reason Simon said he thought telephone therapy was so helpful was that people were more likely to stick with it. In fact, 84 percent completed at least four sessions, according to the study.

With standard psychotherapy, Simon said, people have to be somewhat motivated to get treatment. They have to be willing to find a therapist, then make appointments, and then repeatedly keep those appointments.

And the problem is, Simon said, most depressed people aren't motivated at all. Instead, most feel discouraged.

"The idea here is of a different approach -- vigorous outreach to people who are withdrawn and isolated. Maybe the people who could benefit the most from therapy are those who aren't motivated to get there. It's the value of what's possible over what's optimal," he said.

Dr. Gerald Shiener, a psychiatrist at Beaumont Hospital in Royal Oak, Mich., agreed that in-person therapy is best, but said that he was impressed by the study's results.

"Some contact is better than none," he said. "This study stresses the importance of talk therapy. It really is the cornerstone for the treatment of depression."

The most important thing for people struggling with depression to remember is "that when they're depressed and feeling hopeless, realize that there are treatments that work. And, that counseling is as important as medicine," Shiener said.

More information

To learn more about depression, visit the American Academy of Family Physicians.

SOURCES: Gregory Simon, M.D., M.P.H., psychiatrist and mental health researcher, Group Health Cooperative, Seattle; Gerald Shiener, M.D., psychiatrist, Beaumont Hospital, Royal Oak, Mich.; Aug. 25, 2004, Journal of the American Medical Association

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