Digital Therapy Offers Hope For Depression In Multiple Sclerosis
In a recent research published in The Lancet Digital Health, a phase three multicentre randomised controlled trial, led by Stefan Gold and colleagues, sheds light on a promising avenue for tackling depression in people with multiple sclerosis (MS). MS, a chronic disorder of the central nervous system, presents a myriad of challenges, with depression affecting up to 50 per cent of individuals battling this condition. The study explores the effectiveness of internet-based guided Cognitive Behavioural Therapy (iCBT) as a tool to reduce depressive symptoms in MS patients.
Multiple sclerosis is a chronic condition for which there is currently no cure. While it is not often fatal, it can significantly impact life expectancy and mental health. Depressive symptoms further exacerbate the complexities of managing this condition, leading to reduced physical activity, diminished treatment adherence, and a worsened quality of life. The burden of depression in MS cannot be understated.
Cognitive Behavioural Therapy, or CBT, is a well-established treatment for depressive symptoms in individuals with chronic conditions. With the advent of digital interventions like iCBT, there are new opportunities to provide accessible, effective, and personalized support to reduce depressive symptoms in MS patients. iCBT presents several advantages over traditional face-to-face therapy, including the ability to access treatment from the comfort of one's home, overcoming physical limitations, and providing flexibility during unexpected relapses. Moreover, iCBT has demonstrated cost-effectiveness for both patients and societies.
The recent study involved 279 people from Germany and the USA with multiple sclerosis. Previous trials of internet-based psychological interventions for depressive symptoms in MS had smaller participant numbers and yielded mixed results. However, in this phase three trial, standalone and therapist-guided iCBT showed significant reductions in depressive symptoms compared to treatment as usual, with a 12-week assessment point. Though these reductions were statistically significant, it's important to note that symptoms still lingered above the clinical threshold for depression, underscoring the challenge of achieving complete freedom from depression.
Future efforts should optimise iCBT approaches to bring depressive symptoms below the clinical threshold. The authors suggest tailoring iCBT modules to accommodate the unique needs of individuals with MS, including psychoeducation and cognitive techniques. Tailored packages have proven useful in addressing depression in various populations, and similar customization is essential for MS patients.
To ensure the safety and efficacy of future iCBT programs for chronic health conditions like MS, larger trials must be conducted. However, this endeavour poses challenges, such as assembling multidisciplinary teams comprising psychotherapists, condition specialists, technologists, and individuals with experience in coordinating large trials.
Stefan Gold emphasizes the need for increased funding to support larger comparative trials that specifically evaluate iCBT for different chronic health conditions. These interventions may prove more effective for specific symptom groups or rare conditions, even if they benefit a smaller proportion of the population. Governments and academic centres must step up to provide additional funding, particularly in cases where healthcare is not publicly funded, to cover the costs of iCBT interventions for prospective users.
The recent study signifies a significant step towards alleviating depressive symptoms in people with multiple sclerosis through iCBT. However, more work remains to enhance its clinical efficacy. Adequate funding and tailored interventions are pivotal to ensure that individuals battling chronic illnesses can access and benefit from these digital tools. As we strive for better mental health support for those with MS and other chronic conditions, it is essential that we commit to making these resources available to all who need them.
