Telehealth Improves Depression in Patients With Parkinson Disease

Cognitive-behavioral therapy (CBT) via the telephone was shown to be an effective depression intervention in patients with Parkinson disease (PD). This finding could lead to greater access to care for patients with this unmet need, according to study results published today in Neurology.

Depression affects up to 50% of patients with PD (PwP), but 60% of those with significant symptoms of depression are overlooked, an issue that is associated with greater disease severity and higher healthcare utilization when left untreated.

In prior pilot trials, CBT, a personalized, coping skills—based treatment approach, has shown promise at treating depression among PwP. Although PwP may prefer this option over pharmacologic treatments, physical, geographic, and workforce barriers often limit its reach. The Neurology researchers sought to examine whether telemedicine would provide the personalized neuropsychiatric care required to address this unmet need.

They conducted a randomized clinical trial of 72 patients to evaluate the efficacy of specialized, telephone-based CBT (T-CBT) for depression in PwP compared with community-based treatment as usual (TAU). Patients were randomized to receive either T-CBT with TAU (n = 37) or TAU alone (n = 35), with the primary outcomes being posttreatment group differences in the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes included responder status, depression severity (Beck Depression Inventory [BDI]), anxiety (Hamilton Anxiety Rating Scale [HAM-A]), and quality of life (Medical Outcomes Study Short Form—36 mental health composite score [SF-36 MCS]).

The T-CBT was tailored to each patient’s unique needs and was provided weekly for 3 months, then monthly during 6 months of follow-up. It targeted negative thoughts and behaviors and trained care partners to help PwP practice healthy habits.

Blind raters assessed outcomes at baseline, mid treatment, treatment end, and 1- and 6-months post treatment.

In the study findings, T-CBT was associated with significant improvements in the HAM-D compared with TAU over the course of the trial (F₄₂₄₉ = 14.89; P <.0001) and persisted at the 6-month follow-up. All secondary outcomes improved with T-CBT, compared with TAU, as seen in these results:

• BDI: F₄₂₄₄ = 5.07 (P <.001)
• HAM-A: F₄₂₄₉ = 8.63 (P <.0001)
• SF-36 MCS: F₄₂₄₁ = 3.62 (P = .007).

“These results are exciting because they show that specialized therapy significantly improves depression, anxiety, and quality of life in people with Parkinson disease and also that these results last for at least 6 months,” said study author Roseanne Dobkin, PhD, Rutgers-Robert Wood Johnson Medical School.

The authors note that a limitation of the study was that it did not include patients with very advanced PD or those who had dementia, which may limit applicability of the results.

With 40% of patients engaged in T-CBT meeting the criteria for having “much improved” depression symptoms after treatment, as opposed to none of those undergoing TAU, the implications of this innovative therapy method could prove vital for PwP, noted the study authors.

“In many instances, depression is a more significant predictor of quality of life than motor disability. So easily accessible and effective depression treatments have the potential to greatly improve people’s lives,” said Dobkin.

Reference

Dobkin RD, Mann SL, Gara MA, et al. Telephone-based cognitive behavioral therapy for depression in Parkinson disease [published online April 1, 2020]. Neurology. doi: 10.1212/WNL.0000000000009292.