What’s New in the Treatment of MDD?

1. Smartphone Applications May Be Useful for Managing Depressive Symptoms: An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3414 participants. The participants had a range of mental health symptoms and conditions, including major depression, mild to moderate depression, bipolar disorder, anxiety, and insomnia.[1]

Depressive symptoms, particularly in patients with mild to moderate depression, were reduced significantly more in those who used smartphone apps than in the control groups. There was no difference in apps that applied principles of mindfulness compared with cognitive behavioral therapy or mood monitoring programs.

The results may be promising, but there is no evidence these apps alone can outperform standard psychological therapies or reduce the need for antidepressant medications.

Co-author John Torous, MD, Co-Director of the Digital Psychiatry Program at Beth Israel Deaconess Medical Center and a Clinical Fellow in Psychiatry at Harvard Medical School in Boston, said: “Patients and doctors are faced with a vast array of mental health apps these days, and knowing which ones are actually helpful is imperative. This research provides much needed information on the effectiveness of apps for depression, and offers important clues into the types of apps which can help patients manage their condition.”

2. Older Adults With MDD Have Comparable Responses to Antidepressant Therapy as Younger Adults: A retrospective secondary data analysis was conducted from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study for 2280 adults with MDD who received citalopram monotherapy. The patients included 106 older adults age 65 or older and 2174 adults under age 65.[2]

Following treatment, both older and younger adults experienced similar significant improvements in patient-reported depressive symptom severity, functioning, and quality of life. Older patients were more likely to have more severe depressive episodes of longer duration, but they responded to treatment as well as younger patients did.

3. A Psychosocial Intervention Improves Early Adherence to Pharmacotherapy Among MDD Patients: In this randomized clinical trial, 231 middle-aged and older adults without significant cognitive impairment received newly initiated antidepressant therapy from their primary care physician and were recruited within 10 days of their prescription. They were randomly assigned to a brief psychosocial intervention or treatment as usual.[3]

The intervention group was 3 times more likely to be at least 80% adherent to antidepressant pharmacotherapy at both 6 and 12 weeks. While this did not have a sustained effect on depression, those who adhered showed greater reduction in depression severity by 24 weeks.

A brief psychosocial intervention that targets medication barriers can improve adherence to a newly initiated antidepressant regimen among middle-aged and older adults.

REFERENCES

1. Firth J, Torous J, Nicholas J, et al. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017;16:287-298. doi: 10.1002/wps.20472.

2. Steiner AJ, Recacho J, Vanle B, et al. Quality of life, functioning, and depressive symptom severity in older adults with major depressive disorder treated with citalopram in the STAR*D Study. J Clin Psychiatry. 2017;78:897-903. doi: 10.4088/JCP.16m11335.

3. Sirey JA, Banerjee S, Marino P. Adherence to depression treatment in primary care: a randomized clinical trial. JAMA Psychiatry. Published online September 27, 2017. doi:10.1001/jamapsychiatry.2017.3047