Log on to beat the Black Dog

In a discovery that could lead to new treatment approaches for depression, researchers from the University of New South Wales (UNSW) have shown that internet-based therapy programs are as effective as face-to-face therapies in combating the illness. Patients in a clinician-assisted internet-based treatment program experienced rates of recovery similar to those achieved by face-to-face therapy, the research found.

Moreover, the program – dubbed the Sadness program – required an average of only 111 minutes of clinician email contact per person over an eight-week period, significantly less than other comparable clinician-based therapies.

A paper outlining the study appears this week in the Australian and New Zealand Journal of Psychiatry.

"The results will come as a surprise to many people who believed internet-based programs wouldn't work in treating depression," said lead author of the study, Professor Gavin Andrews, from UNSW's School of Psychiatry.

"We knew that the internet was successful at treating social phobias and other anxiety disorders but these conditions are, in many ways, low-hanging fruit.

"It was assumed that depression would be more difficult because of the lack of motivation usually associated with the illness," he said.

"But that simply wasn't the case."

In the study, Professor Andrews and UNSW colleague Dr Nick Titov, based at St Vincent's Hospital, randomly assigned 45 people who met diagnostic criteria for depression to the Sadness step program or to a waitlist control group.

Those in the treatment program completed six online lessons and weekly homework assignments, received weekly email contact from a clinical psychologist and contributed to a moderated online forum with other participants. They received an average of eight email contacts each from a qualified psychologist.

After completing the program, more than a third (34 percent) no longer met the criteria to be diagnosed as depressed – a result similar to face-to-face therapy.

A significant majority (82 percent) who completed a post-treatment questionnaire reported being either very satisfied or mostly satisfied with the overall program.

The results replicate those from a pilot trial and are consistent with findings in internet-based trials for other mental disorders.

The findings suggested that the internet could overcome many of the barriers to seeking treatment for depression – including the stigma associated with seeing a mental health professional, the limited availability of clinicians for face-to-face treatment, and the difficulties associated with seeking treatment during working hours.

There were also important implications for people in regional areas or who were otherwise socially isolated.

"The internet program is convenient," Professor Andrews said. "People can use it when they need to, without having to make an appointment or leave the house. Participants were logging in at 1am."

While encouraging, Professor Andrews said the results needed to be followed up with larger trials.

"We're not doing psychologists out of a job just yet, but if these results are replicated in larger trials, internet programs could be utilised extensively to enhance existing mental health services."

Source: University of New South Wales