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David Baxter PhD

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New Therapy on Depression Finds Phone Is Effective
August 25, 2004
by Benedict Carey

Debates about the safety and effectiveness of treatments for depression miss a basic reality about the disease: most people affected by it do not seek help at all, and those who do commonly neglect to complete counseling or drug regimens recommended by doctors. For at least a third of the people who try them, treatments of any kind fall short, surveys show.

But improving success rates may be a matter of picking up the phone, according to a report today in the Journal of the American Medical Association. In a large-scale, 18-month study, doctors in Seattle found that they could significantly increase recovery rates for patients taking antidepressants by providing several 30- to 40-minute counseling sessions over the phone.

In previous studies, researchers showed that phone calls from nurses or other clinic staff members providing emotional support could help people trying to quit smoking, stay on medication or shake low moods. The Seattle study is the first to test the effect of a standardized form of counseling, cognitive behavior therapy, delivered entirely over the phone.

"It's thrilling to see these kinds of results," said Dr. Jeanne Miranda, a professor of psychiatry at the University of California, Los Angeles, who was not involved in the study. "I do this kind of therapy in person, and it is often very hard getting some people to come in; they want the help but are just too busy to find time in their schedule, and on the phone they can do it on their time."

It is not clear from the study whether phone counseling will be equally helpful for everyone with depression. The Seattle researchers focused on patients who sought treatment and were motivated enough to begin taking drugs. Dr. Jürgen Unützer, a psychiatrist at the University of Washington who was not involved in the study, said that only about a quarter of all Americans suffering from the illness try drug therapy each year. The rest do not, because of lack of awareness, access or interest, psychiatrists say, and many people with depression are wary of taking mood-altering drugs.

But because 40 percent of the people who begin antidepressant therapy quit within the first month, doctors should consider the telephone a powerful ally, said the study's lead author, Dr. Gregory E. Simon, a psychiatrist at the Group Health Cooperative, a 500,000-member health plan in Washington.

"This represents an important change in the way we approach treatment," Dr. Simon said, "not only using the phone, but being persistent, proactive, reaching out to people and finding them where they are. Depression is defined by discouragement; very often they're not going to come to you."

The researchers followed 600 men and women receiving antidepressant treatment at Group Health clinics. The patients were randomly assigned to one of three treatment plans: usual care, in which they were instructed simply to follow their prescription; telephone management, in which they received two phone calls and a mailer with advice and support for continuing the prescription; and phone therapy, in which trained counselors provided up to eight sessions of advice on how to combat the negative thinking and inertia that fuel depression. Participants in the last group also had workbooks that reinforced the phone therapy, and counselors encouraged them to do homework between sessions.

"One thing we had them do was to list their 10 most common negative thoughts, and then when they had one, to write it down, 'O.K., that was Thought No. 3,'" Dr. Simon said. "This is a way of practicing stepping back from those thoughts and seeing their effect."

By the end of the study, 80 percent of those who had received phone therapy said their depression was "much improved," compared with 55 percent of those who were given usual care. Of those who received encouragement by phone but not explicit therapy, 66 percent said they were "much improved."

The researchers do not know what component of the phone therapy made it effective or whether the increased attention itself made patients feel better. But for therapists trying to treat patients who are overwhelmed or hard to reach-single parents, low-income people. for example - the study may provide an alternative to in-person care.

In rural areas, where stigma can be a barrier to treatment, it is nearly impossible to visit a therapist discreetly, Dr. Miranda of U.C.L.A. said.

"I was working in rural Idaho, where there's really only one mental health worker, and everyone knows where that person works and what their car looks like," she said. "By working on the phone, you can catch people at home and they have some privacy."
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