A randomized controlled trial published in the current issue of Psychotherapy and Psychosomatics indicates how a psychological intervention by internet may be helpful in mild to moderate depression. Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. Authors tested the hypothesis that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults.

This study was a controlled, randomized and assessor-blinded trial in which participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14), recruited from clinical and non-clinical settings, were randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity measured using the PHQ-9. The main analysis was based on the intention-to-treat principle and used linear mixed models. A total of 1,013 participants were randomized.

Changes in PHQ-9 from baseline differed significantly between groups (t825 = 6.12, p < 0.001 for the main effect of group). The post-assessment between-group effect size in favor of the intervention was d = 0.39 (95% CI: 0.13-0.64). In addition, results were still stable at follow-up (d = 0.32 95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10).

Authors concluded that evidence-based Internet interventions should be added to the repertoire of currently available treatments for depressive symptoms. Implementing effective Internet interventions in routine care could substantially alter the way mild to moderate depressive symptoms are treated in general medicine, where interventions must be not only effective but also easily accessible. Whether this intervention is as effective as medication or psychotherapy could be investigated in head-to-head trials. A particularly important next step, though, concerns the broader dissemination of this and other evidence-based psychological Internet interventions.

Article: Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial, Klein JP, Berger T, Schröder J, Späth C, Meyer B, Caspar F, Lutz W, Arndt A, Greiner W, Gräfe V, Hautzinger M, Fuhr K, Rose M, Nolte S, Löwe B, Andersson G, Vettorazzi E, Moritz S, Hohagen F., Psychotherapy and Psychosomatics, doi: 10.1159/000445355, published June 2016.