Aug. 24, 2004 — A novel approach to the treatment of depression that combines psychotherapy by telephone with antidepressant medication could benefit many depressed people who are currently not being helped, new research shows.

Depression is highly treatable with drugs, psychotherapy or a combination of the two, but studies show that less than a third of those with depressive disorders get the therapy they need. The new findings support the idea that vigorous outreach is key to reaching the large percentage of depressed people who are not receiving adequate treatment, says psychiatrist and researcher Gregory E. Simon, MD.

Therapists were better able to keep up with less-motivated patients by calling them on the telephone than they would have been in an office setting, Simon says. When a patient missed a telephone appointment, the therapist would just keep calling.

In the new study published in this week’s Journal of the American Medical Association, Simon and colleagues showed that depressed patients who received eight 30- to 40-minute sessions of structured behavioral therapy by telephone shortly after starting antidepressants had better outcomes than patients who got their usual care.

“The traditional training for many therapists, myself included, says that people who aren’t motivated probably aren’t good candidates for psychotherapy,” he tells WebMD. “We are turning this idea on its head and saying that the people who are very motivated to seek depression treatment may be the ones who least need our help.”

Call for Help

The study included 600 patients starting on antidepressants who were members of a large, Seattle-based managed care group. The participants were randomized to receive either their usual follow-up care, usual care plus three telephone calls to assess the effectiveness and side effects of the antidepressant medication, or their usual care combined with the eight cognitive-behavioral psychotherapy counseling sessions by telephone.

Six months after beginning drug treatment, 80% of the patients who received phone-based psychotherapy reported that their depression was “much improved” or “very much improved,” compared with 66% of patients who received telephone calls regarding their medication and symptoms and 55% of patients who got their usual care for depression.

A total of 59% of patients who got psychotherapy in addition to antidepressant medications reported being “very satisfied” with their depression treatment, compared with just 29% of those who received telephone calls about their medications.

None of the patients in the study originally sought psychotherapy, indicating that the telephone-based psychotherapy approach can reach patients who don’t see themselves as candidates for counseling, Simon says.

“With this approach we don’t require that people commit to being in psychotherapy,” he says. “We don’t even require that they say they are depressed.”

More Study Needed

The study’s main message, Simon says, is that mental health professionals need to be more aggressive in reaching out to less-motivated patients. The research team plans to conduct further studies comparing the telephone-treatment approach with office-based psychotherapy.

“We never had anyone say, ‘Stop calling, you’re bothering me,'” he says. “But many people did tell us how thankful they were that we didn’t give up and stop calling.”

American Psychiatric Association spokesman Darrel A. Regier, MD, MPH, says better patient follow-up is an increasing focus of depression treatment. The APA is currently conducting a pilot study designed to improve monitoring of patients starting antidepressants. Regier says this is being done because so many patients abandon drug therapy, either because they don’t feel the medications are working or because of side effects.

Regier calls the telephone-treatment approach intriguing, but says it might be difficult to implement in the current health care environment. He points out that a third of the patients approached by Simon and colleagues refused to participate, indicating that a large percentage of depressed people would not consent to psychotherapy, no matter how it is delivered.

Furthermore, Regier says that it is not clear if the treatment approach can work outside of a managed care setting.

“Will patients agree to pay for this service,” he says. “That is certainly not clear. Before we even try to develop a business model for this treatment we have to make sure that it works.”