MENTAL HEALTH
(continued from page 21)
symptoms at each visit, and having these data immediately available
for clinicians and patients to track progress and make treatment
decisions. A pivotal study in Beijing found that remission rates
from depression were more than doubled by instituting measure-
ment-based care [11,12]. ress is being made. Depression Centers are working to enhance
access to evidence-based care, develop improved treatments, and
help educate clinicians and the general public on mood disorders.
Some promising newer approaches include ketamine and other
drugs with novel methods of action, measurement-based care, and
computer-assisted methods for psychotherapy for depression.
At the UofL Depression Center, patients rate their symptoms
on iPads in the waiting room before each visit. Four ratings are
completed: The Patient Questionnaire-9 (PHQ-9, for depression),
Generalized Anxiety Disorder-7 (GAD-7, for anxiety), The Co-
lumbia Suicide Severity Rating Scale, and the Altman Mania Scale.
De-identified data from these ratings can be examined across all
participating sites to better understand the course of depression and
search for better treatment responses. With over 10,000 patients
participating now and a goal of at least 50,000 in the future, this
measurement-based care system should have a favorable impact on
many lives and provide “big data” for answering questions about
depression. Jesse H. Wright, MD, PhD, is the Kolb Endowed Professor of Outpatient
Psychiatry and the Director of the University of Louisville Depression
Center.
COMPUTER-ASSISTED COGNITIVE-BEHAVIOR
THERAPY
Cognitive-behavior therapy (CBT) is the most heavily researched
form of talk therapy for depression and has been found to be effective
in a very large number of studies [13]. Yet there are many barriers
to obtaining this form of treatment. There are not enough skilled
therapists who can provide CBT, 20 or more treatment sessions may
be required, and scheduling treatment visits is problematic for many
patients. Computer-assisted cognitive-behavior therapy (CCBT)
helps overcome these obstacles by having patients complete much
of their treatment online at times that are convenient for them. A
human therapist is still used, but the amount of time spent talking
with the clinician is reduced, and, in some cases, contact with the
therapist may be via telephone, email or video link.
The UofL Depression Center has pioneered development of
CCBT for depression and has conducted major research studies
sponsored by the National Institutes of Health. In a recent study
published in the American Journal of Psychiatry, CCBT was found to
be highly effective for depression and equal to standard CBT, despite
reduction of therapist contact time by two thirds in computer-as-
sisted treatment [14]. The UofL research group has also completed
a meta-analysis of 40 CCBT studies from around the world and has
confirmed the usefulness and cost-effectiveness of using computer
technology in psychotherapy for depression [15]. A current study
of CCBT at the UofL is examining the effectiveness of this new
treatment in primary care practices in Louisville and Glasgow, Ky.
CONCLUSION
There are many problems in the treatment of depression, but prog-
22
LOUISVILLE MEDICINE
Rif S. El-Mallakh, MD, is a Professor of Psychiatry and Director of the
Mood Disorders Research Program at the University of Louisville.
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