AMSTERDAM — Digital telehealth has become an established part of depression management, and now digital therapies such as virtual reality games and brain stimulation headsets are making their way into routine care alongside traditional approaches, session participants at the HLTH Europe 2024 conference said.
“One of the great benefits of delivering evidence-based mental health care digitally is that individuals don't have to step over the threshold of mental health services,” Dr. Derek Richards, head of research at Dublin-based hybrid care platform Amwell, told the audience on June 18.
“They are not anonymous, but they are distant. [struggle to come] Accept that you need help.”
The main driver for the adoption of digital solutions in psychiatry is staff shortages across all medical specialties in the European region.
“We are facing a shortage of specialists and healthcare workers, both now and in the future,” Franziska van Hall, MD, scientific director of Curamed Kliniken, a private clinic in Germany, and an expert in psychiatry and psychotherapy, told the audience.
Richards added that the already significant global burden of mental illness has been exacerbated by the recent COVID-19 pandemic.
Taken together, he believes that as long as we continue to rely on the current workforce, the demand for psychiatry and psychotherapy will never be met – “even the silent demand” from people who have not yet been diagnosed.
As a result, Van Hall said he is a “strong believer in hybrid care,” adding that “certain diseases, quite frankly, would not even be treatable.” [at all] Without hybrid care.”
Telepsychiatry and Psychotherapy
Digital solutions in psychiatry fall into two broad areas, with the most established and evidence-based being telehealth, designed to support standard depression management through online and digital resources.
“There is a lot of scientific evidence supporting these approaches,” said Umberto Volpe, MD, of the Department of Clinical Psychiatry at the Marche Polytechnic University in Ancona, Italy. Medscape Medical News.
For example, he said, some online psychotherapy programs have been shown to “at least produce results equivalent to face-to-face sessions,” and some research suggests that telehealth solutions “may even be more effective than traditional psychotherapy.”
Volpe noted that it's much easier for patients to reschedule missed appointments, and digital tools can be used to enhance psychotherapy.
Richards agreed, saying such solutions can be “engaging and meaningful, essentially getting individuals to follow the active ingredients of the intervention to achieve clinical outcomes.”
Managing depression digitally
Meanwhile, digital therapeutics – technologies that aim to directly assist in treating mental illnesses rather than simply expanding the reach of traditional treatments – are relatively new.
Volpe noted that there are many apps designed to boost happiness or treat depression, but stressed that they should be considered “as an adjunct to standard medical care.”
He explained that apps “can enhance several aspects” of depression management, which is not just about making a valid diagnosis and prescribing the right medication. Patients need to be followed over time, implement lifestyle changes and adhere to treatment, he said. “These are all aspects that could potentially be managed through digital applications,” he said.
To that end, Van Hall is developing a hybrid digital outpatient clinic at her clinic, where patients can come in three days a week and the other two days are treated through a digital platform that aims to replicate the in-person experience.
“Most clinics are using these digital strategies as extended care — as a supplement to face-to-face therapy,” she noted, which might include individual or group therapy, psychoeducation, exercise or relaxation routines and online diaries.
But Volpe warned that digital therapeutics and apps are largely unregulated, which affects their quality: “Today you want to develop an app for depression, but tomorrow you just put it on the market and that's it. There's no control.”
He said there are industry standards for such apps in Europe, but generally such treatments need to be backed up by well-designed, high-quality clinical studies.
A step into the virtual world
But the digitalisation of psychiatry doesn't stop there: virtual and augmented reality tools and games are now being introduced into clinical settings, and Volpe believes this could help better engage patients with serious mental illnesses, such as severe depression.
He noted that cognitive impairments are common in such situations, and that while cognitive remediation training can be carried out the old-fashioned way with paper and pencil, virtual reality solutions make it more interactive.
Several games have been developed aimed at improving movement and exercise, especially in cases of depression, but also in any condition for which patients are prescribed sedatives.
“Patients tend to be less active,” Volpe said, and the goal is to help them change their lifestyle and get healthier. Several studies have demonstrated that using virtual tools for this purpose is “more effective than just asking patients to go out and do some exercise.”
Brain stimulation at home
Finally, a relatively new treatment for depression has moved from the clinic into the home via digital platforms.
Erin Sevier Lee, CEO of UK-based Flow Neuroscience, said at the session that her company has developed a wearable device that delivers transcranial direct current stimulation to restore neural activity in the brain, thereby alleviating symptoms of depression.
“We combine that with a consumer app and a remote monitoring platform,” she said.
The device showed positive results in a double-blind, placebo-controlled trial, showing that the technology was not only associated with clinical improvements, but also reduced the need for medical appointments, Lee said. Medscape Medical NewsBut the company was surprised by how well it was accepted by patients.
“You could argue there's a bit of self-selection bias among early adopters,” Lee said, but these are people “who had tried everything else and had nothing to lose.”
“What's great for us is that it's expanding to people who've just been diagnosed or new moms, who are really looking for something other than medication. We make it very accessible and approachable, and we walk them through the whole process. And we have a really strong community, so they can talk to others who have tried it.”
The technology is currently in several trials with the UK's National Health Service, and the company is also rolling it out in the US and other countries.
HLTH Europe It's a major healthcare industry event. sponsor It was organized by many companies. The 2024 event took place in Amsterdam from 17 to 21 June.
