Telephone Psychotherapy Effective, Efficient in Treatment of Depression
Medscape Medical News
Janis C. Kelly
October 16, 2009 -- Depressed patients gain more depression-free days if they are treated with telephone care management plus telephone psychotherapy than with care management alone.
In research published in the October issue of the Archives of General Psychiatry, Gregory E. Simon, MD, MPH, from the Center for Health Studies, Group Health Cooperative, Seattle, Washington, and colleagues report that compared with usual care, the telephone care management program added $676 to outpatient health care costs for a gain of 29 depression-free days, whereas the telephone care management plus psychotherapy program added $397 to outpatient costs but produced an additional 46 depression-free days.
Telephone care management plus psychotherapy was cost-effective if a depression-free day was valued at $9; telephone care management alone was cost-effective only if a depression-free day was valued at $20 or more.
"The care management plus psychotherapy program was a better bargain no matter what value we attach to an additional day free of depression," Dr. Simon told Medscape Psychiatry...
Arch Gen Psychiatry. 2009;66:1081-1089. (Link to abstract)
There are plenty of people out there, who get better with a prescription for an antidepressant alone, or with the addition of a short course of CBT. However, psychiatrists (those whom I know, anyway) rarely treat persons represented in that population.
Really, it is more of a proof-of-concept study, showing that it is reasonable to believe that therapy over the phone is not worthless, and that actual psychotherapy is more effective than chatting with people. It also reinforces something we already knew: medication management plus psychotherapy is better than medication alone. The study specifically cannot be used to conclude that telephonic psychotherapy is as effective as face-to-face psychotherapy, or that telephonic psychotherapy alone (without medication management) is effective.
If the idea of telephonic therapy seems strange to you, how about therapy done by a robot? There's an article in The New Yorker that may be of interest:
Robots That Care
Advances in technological therapy.
by Jerome Groopman
November 2, 2009
The article is about physical therapy and cognitive rehabilitation, not psychotherapy, so I won't comment at length. But psychotherapy-by-robot may someday be possible. Although it seems barely comprehensible today, one of my pet hypotheses is that as we get a few more generations of persons who are are accustomed to electronic communication, as opposed to face-to-face communication, it may seem entirely natural.
Brain & Behavior
Comments
Thank-you for pointing out the crucial difference between psychiatric case loads and GP case loads!
This difference is all too easily lost when looking at this type of research.
Posted by: Meat Robot | November 19, 2009 3:25 PM