Computer Based Program Improved Depression in Multiple Sclerosis Patients

Dr Stefan M Gold Institute of Neuroimmunology and Multiple Sclerosis (INIMS) Centre for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf Hamburg, GermanyMedicalResearch.com Interview with:
Dr Stefan M Gold

Institute of Neuroimmunology and Multiple Sclerosis (INIMS)
Centre for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf
Hamburg, Germany

Medical Research: What is the background for this study? What are the main findings?

Dr. Gold: Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system (brain and the spinal cord). In addition to motor symptoms such as walking impairment, patients with Multiple sclerosis frequently suffer from psychological problems including difficulties with learning and memory as well as depressed mood. Depression is particularly common in this patient group with a 3-4 fold elevated risk for developing major depressive disorder compared to the general population. Depression in Multiple sclerosis is associated with decreased quality of life, absence from work, and numerous other psychosocial problems. Despite this major impact on patients’ lives, depression in Multiple sclerosis is often not adequately diagnosed and treated: Antidepressant medication in this patient group often has side effects and the neurological problems associated with MS such as difficulties with concentration and fatigue make it particularly difficult for MS patients to complete “classical” depression treatments such as psychotherapy. The goal of our study was to make psychological treatments available for the many patients with Multiple sclerosis suffering from depression, who often have difficulties to find adequate treatment.

For this study, published in The Lancet Psychiatry, we conducted a randomized controlled trial of a fully-automated, computer-based program that can be accessed directly from patients’ homes over the internet. The program called “deprexis” was developed by the Hamburg-based company GAIA and uses methods of “cognitive behavioral therapy” or “CBT”. Ninety Multiple sclerosis patients were enrolled in the trial and randomly assigned to a 3 months therapy using the deprexis program or a waitlist control group. At the end of the intervention, depression had significantly decreased in the treatment group but remained unchanged in patients who did not have access to the program. In addition, patients using the computer program also reported reduced fatigue and improved quality of life.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gold: We feel that the results of the trial are encouraging because this computer program has several advantages, particularly for patients with Multiple Sclerosis and possibly other chronic disorders that are associated with mobility or cognirtive problems: It can be accessed from anywhere at any time, be completed at the patient’s own pace, and eliminates the need to travel. While such fully-automated computer programs are not suited to replace psychotherapy, they can be useful as a low threshold option for low to moderate depression in a stepped care model or as an interim solution until psychotherapy becomes available.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gold: From a clinical point of view, as this was a relatively small phase II trial, the findings need to be confirmed in larger trials and we are currently in the process of planning an international multicenter study. From a scientific point of view, we are interested in the therapeutic mechanisms. Intriguingly, the high frequency of depression in MS is likely caused by psychological as well as biological factors, since nerve damage caused by Multiple Sclerosis might also affect brain regions that are important for mood regulation and emotions. It will be interesting to see in future studies if successful treatment of depression in MS such as seen with this computer program may also have an effect on the underlying biology.

Citation:

An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial

Anja Fischer, PhD Johanna Schröder, MSc Eik Vettorazzi, MSc Prof Oliver T Wolf, PhD Jana Pöttgen, MSc Stephanie Lau, MSc Christoph Heesen, MD Steffen Moritz, PhD Dr Stefan M Gold, PhD

DOI: http://dx.doi.org/10.1016/S2215-0366(14)00049-2 The Lancet Psychiatry

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MedicalResearch.com Interview with: Dr Stefan M Gold, & Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (2015). Computer Based Program Improved Depression in Multiple sclerosis Patients MedicalResearch.com