Technology in the Clinical Care of Depression: Moving Beyond Face-to-Face Treatment

There’s an app for almost everything nowadays. Need a ride? Use Uber or Lyft. Need food delivered? Try Grubhub or DoorDash. Need (nearly) anything else? Amazon’s got you covered! Technology is an integral part of almost every aspect of our lives, but mental health treatment is often still thought of as only a face-to-face interaction. Thankfully, this doesn’t have to be the case. In a recent issue of The Journal of Clinical Psychiatry, my colleagues and I presented an evidence map of technological interventions in the clinical care of depression. We showed that there is ample existing evidence for the effective treatment of depression using a variety of technologies and treatment modalities.

Depression is highly prevalent in the United States and a leading cause of disability. However, about 30% to 50% of those affected by major depressive disorder receive no treatment at all in this country. Access to treatment is far worse internationally—only 16.5% of those with major depression in middle- and high-income countries receive minimally adequate treatment. Treatment is traditionally delivered via face-to-face interventions. Of course, in-person treatment can be impeded by numerous barriers, including cost, geography, and stigma. Telehealth or telemedicine interventions, that is, communication over the phone, computer, or other technologies, can provide a remote substitute to face-to-face treatment. These interventions vary by technology type (eg, computer, smartphone), function (eg, therapy, support), and administrator (eg, self, provider).

We conducted a systematic review of the literature on technological interventions for depression and summarized our findings using several evidence maps. Each study that we included is represented by a point on a scatter plot, and its shade and grid position represent various study characteristics. This method allows the reader to see a quick visual summary of the research on a topic, including areas of high and low evidence.

Our team searched the PubMed, PsycINFO, and Web of Science databases from inception to June 2017 and found 4,062 records, including 161 randomized controlled trials (RCTs) of technological interventions for depression. Most of these RCTs were published within the last 5 years of the search, but we found research conducted as far back as 1991. The most common types of intervention included self- or provider-directed therapy by computer or phone. Ninety percent of all included studies reported symptom improvement. Only 8 RCTs examined smartphones, while 98 utilized computer interventions. Self- and provider-directed interventions were very common compared to automated treatments, but relatively little research compared treatment effectiveness using different technology administrators. We also found many interventions comprising multiple technology types or functions or other uncategorized technology types or functions. Further investigation, in terms of both clinical research and systematic reviews, should be undertaken to address these gaps in understanding.

Technological interventions for depression offer a promising alternative to traditional face-to-face treatment. In an era of on-demand digital access to nearly every good or service, why should mental health treatment be confined to the brick-and-mortar? While we all enjoy easy access to takeout meals or online shopping, on-demand depression treatment offers a far greater benefit to those affected by depression and society overall.

The contents of this article do not represent the views of the US Department of Veterans Affairs or the United States Government.

Financial disclosure:Dr Apaydin has no conflicts of interest to disclose.