AMSTERDAM — Digital telemedicine has become a well-established part of depression management. Now, digital therapies like virtual reality games and brain stimulation headsets are making their way into everyday care alongside traditional approaches, heard participants at a session here at the HLTH Europe 2024 conference.
"One of the great advantages of digitally delivering evidence-based mental healthcare is that an individual doesn't have to walk over the threshold of a mental health service," Derek Richards, PhD, head of research at the hybrid care platform Amwell, Dublin, told the audience on June 18.
"They're not anonymous, but they have a distance that can be really helpful for individuals who [struggle to come] to terms with needing help."
A central driver for the adoption of digital solutions in psychiatry has been staff shortages across the European region in all medical specialties.
"We face a lack of specialists and a lack of medical personnel" both now and in the future, Franziska van Hall, MD, scientific director and specialist in psychiatry and psychotherapy at German private clinic, CuraMed Kliniken, told the audience.
Richards added that the already large global burden of mental health disorders has been exacerbated by the recent COVID-19 pandemic.
Taken together, he believes that demand will never be met for psychiatric and psychological care — not "even the silent demand" from as-yet undiagnosed individuals — if reliance remains on the current workforce.
Consequently, van Hall said she is "a big believer in hybrid care," adding: "Honestly, we won't even be able to manage certain diseases [at all] without hybrid care."
Distance Psychiatry and Psychotherapy
Digital solutions in psychiatry fall into two broad areas, the most established and evidence-based being telemedicine, which is designed to support standard depression management through online and digital resources.
"There is a lot of scientific evidence" in support of these approaches, Umberto Volpe, MD, PhD, chair of the Clinical Psychiatry Unit at Università Politecnica delle Marche, Ancona, Italy, told Medscape Medical News.
Some online psychotherapy programs, for example, have demonstrated "at least the same results that you get in person," he said, with some studies suggesting that telemedical solutions "can be even more efficient than traditional psychotherapy."
Volpe pointed out that, for patients, it's much easier to reschedule if they cannot make an appointment, and digital tools can be used to enhance their psychotherapy.
Richards agreed, saying that such solutions can be "engaging and meaningful, and basically get individuals to adhere to the active components of the intervention in order to achieve a clinical outcome."
Managing Depression Digitally
On the other hand, digital therapies, in which the technology aims to assist in treating the mental illness directly, rather than simply to extend the reach of traditional interventions, are a relative newcomer.
Volpe noted that there are a lot of apps available that are designed to increase well-being or even treat depression. However, he underlined that they should be considered as "companions to standard treatments."
Apps, he explained, "can enhance some aspects" of depression management, which should not only be about making a valid diagnosis and then prescribing the appropriate drug. Patients need to be followed up over time, he said, lifestyle changes need to be implemented, and treatment needs to be adhered to. "These are all aspects that might be managed through digital applications," he said.
To this end, van Hall said her clinics are developing a hybrid digital outpatient clinic, which allows patients to attend 3 days a week. On the other 2 days, they do their therapy via a digital platform that aims to reproduce the in-person experience.
She pointed out that "most clinics use these digital strategies as augmented care, so as an add-on to face-to-face therapy, for example," and could include individual or group therapy, psychoeducation, exercise and relaxation routines, and online diaries.
However, Volpe cautioned that digital therapies or apps are largely unregulated, affecting their quality. "You may want to develop an app for depression today, the next day put it on the market, and that's it. There's no control over it."
He said there are industry standards for such apps in Europe, but in general, such therapies need to be supported by well-designed, high-quality clinical studies.
Stepping Into the Virtual World
But the digitization of psychiatry doesn't stop there. Virtual or extended reality tools and games are now entering the clinical setting, which Volpe believes may be helpful in increasing the engagement of patients with severe mental illnesses, including major depressive disorder.
He pointed out that cognitive deficits are common in such conditions, and while cognitive remediation training can be performed in the old-fashioned way with paper and pencil, virtual reality solutions make it more interactive.
Several games have been developed that aim to improve movement and exercise, particularly in depression but also in any condition in which patients are prescribed sedatives.
"They tend to move less," Volpe said, and so the aim is to change their lifestyle to make them healthier. Several studies have demonstrated that using virtual tools for this purpose is "more efficient than just asking your patient to go out and do some sort of exercise."
Home-Based Brain Stimulation
Finally, a relatively novel treatment approach for depression has taken a step away from the clinic and into the home via a digital platform.
Erin Sivyer Lee, CEO of Flow Neuroscience, England, told the session that the company has developed a wearable device that can deliver transcranial direct current stimulation to help restore neural activity in the brain and, in so doing, relieve depressive symptoms.
"We pair that with a consumer-facing app and a remote monitoring platform," she said.
The device had positive results in a double-blinded, placebo-controlled trial that showed the technology was not only associated with clinical improvements but also reduced the need for healthcare appointments, Lee told Medscape Medical News. But even the company was surprised by the way it was taken up by patients.
"You can argue that there's a little bit of self-selection bias between the early adopters," Lee said, but they "are people who have tried everything else and had nothing to lose."
"What has been awesome for us is watching that expand to people who are just recently diagnosed or new mothers, and people really want something other than drugs. We make it very easy to use, we make it friendly, we walk people through the process, and then we have a very robust community, so they can talk to other people that have tried it."
The technology is now being tested by the UK National Health Service in several pilots, and the company is rolling it out in the United States and other countries.
HLTH Europe is a large-scale healthcare industry event sponsored by many companies. The 2024 event was held in Amsterdam from June 17 to 21.