An internet-based cognitive-behavioral therapy (iCBT) program specifically designed for patients with multiple sclerosis (MS) significantly reduced depressive symptoms compared to usual treatment, new research shows.
Participants in the randomized controlled trial who received iCBT either alone or in combination with weekly emails from therapists reported benefits that persisted up to a year after therapy.
Although some patients who received iCBT continued to show signs of clinical depression after the treatment, investigators note that overall, the findings suggest that an internet option could help address depression in people with MS.
“These scalable remote-access options might be something that is a low-barrier first line of treatment or at least as support for somebody where the clinical infrastructure or the access to real live therapists is not there,” lead investigator Stefan Gold, PhD, professor of neuropsychiatry, Charite Universitätsmedizin Berlin, Germany, said at a presentation at the 38th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2022.
Depression is common in patients with MS, and patients with MS who also have depression are at increased risk of mortality compared to people with one or neither condition.
“Depression is one of the most common comorbidities in multiple sclerosis, affecting about 25% of the patients,” Gold said. “Depression is not only associated with psychosocial burden, but it’s also linked to faster disability progression, higher morbidity, and even higher all-cause mortality.”
The phase 3, three-arm trial was conducted in five centers in Germany and the US. Patients received iCBT alone (n = 101), iCBT combined with weekly emails with a chat option from therapists (guided iCBT; n = 85), or treatment as usual (control; n = 93).
At study outset, all participants had self-reported moderate depression. About half were taking antidepressants at baseline, and about 8% were seeing a therapist at least once a week.
At 3 months, participants in the iCBT groups were reassigned to a group that received booster sessions. Participants in the control group were offered access to iCBT after 6 months. The primary outcome was improvements in the Beck Depression Inventory – II (BDI-II).
Both versions of the iCBT program significantly reduced depressive symptoms at week 12 compared to treatment as usual (BDI-II between-group mean difference vs control: stand-alone iCBT, 6.32 points; P < .0001; guided iCBT: 5.80 points; P < .0001).
Although the benefits of iCBT persisted at 12 months, there was no added benefit from booster sessions.
Self-reported quality of life was improved with iCBT, but there was no improvement on overall fatigue.
There were no reports of suicidality, and only one person who received iCBT reported clinically relevant worsening of depressive symptoms, compared to three in the control group.
“Posttreatment levels remained above the clinical cutoff for at least some of the participants, so if you look at the descriptive values, we still have work to do,” Gold said. “So, this is certainly not something that completely gets rid of the problem of depression, and I think that calls for integrative and stepped-care approaches.”
The study was funded by National Multiple Sclerosis Society. Gold has received honoraria from Hexal and Celgene and research grants from Biogen.
38th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2022: Abstract 0115. Presented October 27, 2022.
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