Telemedicine may work as well as in-person visits for depression

doctor and woman with neck pain in front of laptop (iStock)

Treating depression with video conference calls may offer symptom improvement similar to in-person visits, a recent U.S. study suggests.

Researchers randomly assigned 241 depressed elderly veterans to receive eight weeks of psychotherapy either by visiting a clinician's office or by using in-home videoconferencing technology. All of them could also take antidepressants.

After one year, there was little or no meaningful difference in satisfaction or symptom relief between the two groups, the study found.

"Based on results of this study and prior research, telemedicine is a highly relevant option to address the needs of rural patients or those living in remote locations, while providing patient satisfaction and quality of life similar to that provided by in-person treatment delivered at clinics," said lead study author Dr. Leonard Egede, a researcher at the at the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center in Charleston.

"In addition, this study was focused specifically on the elderly population, who have limitations in terms of mobility and transportation options that make them good candidates for depression therapy using telemedicine," Egede added by email. "Based on our analyses, there are no sub-populations based on age, race, or gender that showed worse outcomes and therefore would require in-person treatment."

Even though depression affects roughly one in 10 Americans and is a leading cause of death and disability, close to half of patients with depression don't get treatment, researchers note in the Journal of Clinical Psychiatry.

When depression goes untreated, it's often because people can't overcome issues with mobility, travel distance, transportation costs or time off work - all of which may be addressed by telemedicine.

To see how patient satisfaction with telemedicine stacked up against in-person therapy for depression, researchers examined data on male and female veterans aged 58 and older.

Most of the elderly veterans enrolled in this study were men, and the majority were white. Patients with active psychosis, dementia, a substance dependence or suicidal thinking and clear intent were excluded from the trial.

The telemedicine group used cameras paired with video monitors that worked with a phone line so they didn't need to have Internet access for the experiment.

Among other things, researchers asked participants about their physical function, emotional problems, energy and fatigue, pain, social functioning and general health. On all of these measures, results were similar for telemedicine and in-person therapy by the end of the one-year study.

Researchers also asked participants about how credible they found the treatment to be and their satisfaction with it and found no meaningful differences between the two groups in the study.

One limitation of the study is the exclusion of patients with substance abuse issues, acute mental health problems or dementia, which the authors note may restrict how much the findings apply to many patients with depression.

Still, the findings add to existing evidence suggesting telemedicine can work as well as in-person visits, said Dr. Charles Hoge, a scientist at Walter Reed Army Institute of Research in Washington, D.C., who wasn't involved in the study.

"Advantages of telemental health treatment include reducing stigma, improving access for patients located in remote locations, and enhancing services to those with chronic health problems that restrict their mobility," Hoge said by email.

Even though this study focused on older veterans, telemedicine may have broader appeal, said Alan Peterson, a researcher at the University of Texas Health Science Center at San Antonio who wasn't involved in the study.

"The results of this study - which focuses on a difficult to reach population - suggest that similar positive outcomes are also likely for other patient populations such as those with comorbid substance abuse or acute mental health problems," Peterson said by email.

"This treatment approach might be especially attractive to younger populations who may be even more receptive to computer or other technology-based approaches to healthcare," Peterson added.