Can online therapy help with depression?

Depression is one of the most common mental illnesses, with an annual incidence rate of 6% in Germany among people between the ages of 18 and 79.

Most of those affected are not aware that they are suffering from a depression that requires treatment. This explains why people who seek psychiatric help for the first time are very ill because they have been suffering from the symptoms for a long time and are therefore experiencing a high level of distress.

This is a phase in which treatment is also significantly more difficult. They are people who have been suffering from a persistent depressed mood for several weeks or even months. You hardly feel any energy, have serious sleep disorders, and are desperate. Sometimes there are even suicidal thoughts. In the social aspect, the disease shows that those affected hardly have any contact with family or friends, they withdraw, appointments that have already been confirmed are cancelled. If there is no sick leave yet, the level at work is reduced to a “survival mode”.

A characteristic of people who have noticed over 2-3 weeks that they are moodily depressed for no explicable reason is that they have little drive to get up in the morning.

They cannot concentrate well at work and sufferers are often awake for hours at night. Such phases are often regarded by laypeople as “something normal”, although according to the ICD criteria (= international statistical classification of diseases and related health problems), even a mild depressive illness can be diagnosed professionally. However, there are cases in which an insidious deterioration can lead to a major depressive illness.

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Is antidepressant treatment enough?

Regardless of the cause of depression, drug treatment is almost standard. The aim of drug therapy is to try to restore the disturbed function of the various messenger substances whose imbalance is considered the biological basis of depression. The most important messenger substance is serotonin, but norepinephrine and dopamine are also affected. Treatment in Germany is based on the so-called S3 National Care Guideline, which is based on the current state of scientific knowledge on the diagnosis and treatment of depressive disorders.

Drug treatment is anything but easy. The patient can be expected to take an antidepressant for at least 10-14 days to assess whether the prescribed medication is helping. possibly This is then increased further so that the patient’s mental state can only be reassessed a week or two later. This period requires a lot of patience on the part of the patient. In addition, the patient sometimes has to deal with side effects of the medication in addition to the depressive symptoms.

Sometimes it is unavoidable to prescribe a second drug or to change everything if the effect is insufficient. For the patient, this means that “everything starts all over again”.

In addition to the administration of psychotropic drugs, psychotherapy has shown positive effects in the treatment of depression in various studies. However, the effect of psychotherapy depends on the duration and severity of the episode.

Does online therapy help with depression?

In order to gain access to psychotherapy, one must first overcome various hurdles. In addition to bureaucratic aspects (there are long waiting times until the first appointment), it is usually the case that the appointment is made at a rather unfavorable time of day. However, the patient still perceives it because he feels a high level of suffering and would like to receive help. The journey to the therapist’s office is the next stressor (heavy traffic, bus or train delays, etc.), so once the patient arrives at the office, he or she would need some time to relax before he is upset can engage in psychotherapy. For people who live in rural areas and do not own a vehicle, it is almost impossible to overcome such hurdles.

As is well known, there is an attempt to find a solution for every problem. Various online therapies are now being offered. However, it is questionable to what extent online therapy can help with mental illnesses, especially depression.

As early as 2009, 10 studies in a meta-analysis (1) showed a significant improvement in symptoms of depression with the help of online therapies. Other studies over the last few years have only shown positive results regarding online therapy for depression. Recently, it was even the case that in a study in Sweden (2) from December 2019, a comorbidity (= concomitant disease), e.g. an anxiety disorder, had no negative impact on online therapy.

The results in the above studies showed positive outcomes of patients treated with online therapy compared to test subjects who had not received online therapy, the so-called “control group”. It was exciting to know to what extent the online therapy works compared to patients who receive “face-to-face”, i.e. direct/classic psychotherapy. In a study (3) from December 2013, no difference could be observed, even 3 years after the treatment.

Since the Germany-wide implementation of the Digital Health Care Act (DVG) on December 19, 2019 (4), online therapy has also been regulated by law.

Oh yes, it should not be forgotten to mention that the above studies were carried out with patients with mild to moderate depression. As said at the very beginning, in severe depression, the effect of psychotherapy is minimal. Since a mild to moderate phase can often be a harbinger of severe depression, timely psychotherapeutic intervention would save suffering, time and money in many cases.
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studies

1. https://www.tandfonline.com/doi/abs/10.1586/erp.12.67?journalCode=ierp20

2 https://www.researchgate.net/publication/338226190_Internet-based_CBT_for_patients_with_depressive_disorders_in_primary_and_psychiatric_care_Is_it_effective_and_does_comorbidity_affect_outcome

3 https://www.sciencedirect.com/science/article/abs/pii/S0165032713006563?via%3Dihub

4. https://www.bundesgesundheitsministerium.de/digitale-versorgung-gesetz.html

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