Ringing Out Despair: Phone therapy gets call as depression buster

It may be time for mental-health workers to pick up a new depression-fighting tool—the telephone. People taking antidepressant drugs for a bout of depression do particularly well, at least over a 6-month period, if they also take part in a program that includes telephone psychotherapy, a new study finds.

Evidence of telephone therapy’s mood-enhancing effect raises the prospect of expanding the reach of depression treatment, says the investigation’s director, psychiatrist Gregory E. Simon of Group Health Cooperative in Seattle. Many people suffering from depression don’t take antidepressants—even if the drugs have been prescribed for them—and never receive psychotherapy of any kind. Feelings of discouragement when a medication doesn’t work right away and the stigma associated with psychological treatment contribute to this problem, Simon holds.

“With this telephone program, we can help many depressed people who aren’t reached by traditional in-person treatments,” he says. Simon and his coworkers describe their results in the Aug. 25 Journal of the American Medical Association.

Between November 2000 and May 2002, the researchers recruited 600 adults who were beginning antidepressant treatment at medical clinics run by Group Health Cooperative, a prepaid health plan. Generally, primary care physicians had prescribed fluoxetine (Prozac) or related medications. The study excluded people who were already receiving in-person psychotherapy or planned to do so.

Participants were randomly assigned to one of three treatments: typical primary care follow-ups; typical care plus at least three “care-management” telephone calls over 3 months from mental-health clinicians, who checked on medication use and provided feedback from a patient to his or her primary care physician; and typical care plus care management and eight sessions of cognitive-behavioral therapy delivered by phone.

During the cognitive-behavioral therapy, the clinician and patient discussed ways to increase pleasant activities, reverse negative thoughts, and manage daily affairs. Each session lasted 30 to 40 minutes.

Six months after a person’s treatment began, 80 percent of those who received telephone psychotherapy reported a marked decline in depression symptoms, compared with 66 percent of the care-management group and 55 percent of those who got only typical primary care follow-ups. Participants who received telephone psychotherapy reported the most satisfaction with their treatment.

Psychiatric interviews conducted by phone at that time also found that interviewer-detected signs of depression had diminished most sharply in the telephone-psychotherapy group. These results fit with evidence that cognitive-behavioral therapy delivered in person boosts the effectiveness of antidepressant drugs (SN: 8/21/04, p. 116: Lifting the Mood: Depressed teens benefit from combined therapy).

Psychologist Alan E. Kazdin, director of Yale University’s Child Conduct Clinic, regards Simon’s project as part of a broad movement to make psychological treatments more easily available through sources such as the Internet and self-help manuals, as well as the telephone.

“Telephone psychotherapy won’t replace typical psychotherapy, but it will add to what clinicians can do,” he says. “We can help more people if we have a diversified portfolio of treatments for mental disorders.”