Major depression is a universal mental health problem that has a great impact on the capacity of people to contribute to society. It is a mental problem which is considered very much on the rise with the World Health Organization predicting that by 2030 it will be considered the mental disorder with the greatest negative impact in developed countries. Psychological treatments are seen as an established and verified form of treatment for depression and there are a range of interventions available for the treatment of depression. But how do we start to evaluate what is the best way to treat depression particularly in primary care settings?
Most of us who seek help for depression do so through our local General Practitioner or clinic. We do not go to specialized Psychiatric Clinics or hospitals and while we may indeed feel depressed, our presentation is obviously less severe and we often present with bodily concerns such as a drop in appetite or sleep disturbances in comparison to people who are treated in specialized settings. While this is the experience of most of us research in the field is largely conducted in more specialized settings which has limited relevance for the person with milder depression seeking help from their local GP.
A recent study by Linde et al (2015) sheds some light on what psychological treatments are of most benefit to you or me when we go off to our local clinic and complain of feeling depressed. Linde asked this question in the following way: What kind of psychological treatments are effective for depressed patients in primary care settings (in comparison to placebo or usual care)? He attempted to answer this question by conducting a systematic review of available studies.
Linde’s research included 30 studies (involving a total of 5,159 primary care patients) that he sourced from various psychological data bases. All of these studies met inclusion criteria as randomized, controlled research trials which assessed psychological interventions in comparison to placebo or usual care. Psychological interventions identified included in-person CBT (Cognitive Behavioral Therapy), problem-solving therapy, interpersonal psychotherapy and various other face-to-face therapies. Remote CBT therapy, problem solving therapy, guided self-help CBT and minimal contact CBT were also included. The various approaches were compared primarily on the basis of scores on depression inventories.
The findings of the review showed evidence for the efficacy of psychological treatments, particularly CBT, in depressed patients in primary-care settings. What was interesting to note is that less intensive, remote interventions (telephone or computer–based) seemed to have a similar effect in comparison to more intensive face-to- face interventions. Less resource intensive telephonic or computer based therapeutic processes fared no worse than direct intensive contact with a therapist.
These findings have interesting implications for the field of online psychotherapy. While they are based on a limited number of studies with generally small sample sizes, they seem to indicate that depressed patients in primary care settings can be well served by remote services such as online psychotherapy and computerized mental health services. This opens the opportunity for effective psychological interventions, by widening the net to extend beyond geographical boundaries. It means that people in need of treatment for depression and the policy makers that attempt to serve these people don’t necessarily have to provide qualified clinicians in close proximity to patients looking for the best way to treat depression. This opens up a world of possibility in utilizing less resource intensive and cost-effective treatments with tremendous versatility in terms of the mode of delivery of psychological interventions and the nature of the intervention itself. It also unlocks the possibility of tailoring and combining interventions according to the specific needs and preferences of patients seeking treatment for depression. These findings hold a lot of promise but more relevant research is needed in order to guide policymakers and primary care practitioners in ensuring the best treatment for depression.
Linde, K, Sigterman, K., Kriston, L, Gerta, R. , Rucker, G., Jamill, S., Meissner, K. and Scneider, A. (2015) Effectiveness of Psychological Treatments for Depressive Disorders in Primary Care: Systematic Review and Meta-Analysis. Annals of Family Medicine, January/February 2015 vol. 13 no. 1 56-68