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Telephone Psychotherapy Enhances Antidepressant Pharmacotherapy

Symptoms improved in depressed patients receiving telephone psychotherapy and they reported great satisfaction with this care.

Stigma, depression-related pessimism, and insurance limitations interfere with access and adherence to depression treatments. Although medication availability has increased, dissemination of evidence-based psychotherapies remains extremely limited. These researchers randomized 600 depressed primary care patients beginning antidepressant-drug treatment to usual care, a telephone care management protocol found to enhance antidepressant adherence, or telephone management plus eight sessions of cognitive-behavioral psychotherapy treatment given by telephone. Masters-level clinicians administered both telephone programs; blinded raters assessed patients at 6 weeks, 3 months, and 6 months.

Of telephone psychotherapy (CBT) recipients, 84% completed four or more sessions, and 63% completed at least seven; 85% of care management recipients completed all three telephone contacts. Significantly more telephone psychotherapy recipients than usual care recipients had 50% reductions in clinical depression scores (58% vs. 43%), rated their depression as "much improved" (80% vs. 55%), and reported high satisfaction with treatment (59% vs. 29%). Compared with usual care, care management had a slight, but still significant, benefit in patient-rated improvement and satisfaction but not in depression scores. Rates of attaining adequate medication for 90 days were nonsignificantly higher with the telephone protocols than with usual care.

Comment: This new and probably controversial study demonstrates that depressed patients receiving telephone psychotherapy have improved depressive symptoms and report great satisfaction with this care. In general, fewer than a third of depressed patients receive psychotherapy, only half of whom attend at least four sessions: We need novel approaches to improve the reach of psychotherapeutic treatment. Although this study's results are modest, they suggest that patients might not need the richness of in-person contact to benefit from psychotherapy. Because contact time was greater with psychotherapy, we do not know whether the CBT techniques themselves were essential for this effect.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry September 8, 2004

Citation(s):

Simon GE et al. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: A randomized controlled trial. JAMA 2004 Aug 25; 292:935-42.

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