Therapy given over the phone can help to lessen symptoms of depression in people with Parkinson’s disease, a new study suggests.
The study, “Telephone-based cognitive behavioral therapy for depression in Parkinson disease,” was published in Neurology.
Although often thought of as a movement disorder, Parkinson’s non-motor symptoms are increasingly seen as important in both understanding and treating the disease. About half of its patients experience depression.
“The psychological complications of Parkinson’s disease have a greater impact on the quality of life and overall functioning than the motor symptoms of the disease,” Roseanne Dobkin, PhD, a professor at Rutgers University and study co-author, said in a press release.
“Untreated, depression can accelerate physical and cognitive decline, compromise independence and make it more difficult for individuals to proactively manage their health,” she added, including adhering to medication schedules and exercising.
Cognitive behavioral therapy (CBT), a type of psychotherapy that aims at breaking patterns of negative thinking and helps patients cope with the challenges of their disease, has shown promising results in treating depression in Parkinson’s patients.
Yet, getting this kind of therapy typically requires physically going to a therapist for an hour, a logistical constraint that makes CBT inaccessible to a lot of people — even before the current pandemic made such visits impossible.
Providing CBT through a telephone call, rather than in-person, could help to overcome this obstacle.
Researchers reported the results of a clinical trial (NCT02505737) testing the effectiveness of over-the-phone CBT in treating depression in patients.
In the trial, 72 people (35 male, 37 female, average age of 65.22) diagnosed with both Parkinson’s and depression were randomized to either treatment-as-usual (TAU) , or over-the-phone CBT in addition to TAU. TAU consisted of standard of care; for example, most of the participants were being treated with levodopa and/or antidepressants.
The 37 patients in the CBT group received one hour of over-the-phone CBT once each week for 10 weeks. They then had the option to continue with once-a-month sessions for an additional six months.
Participants’ depressive symptoms and quality of life were measured with standardized questionnaires before beginning CBT, after the initial 10-week treatment, and after the six-month follow-up. In the TAU-only group, symptoms were measured at the same timepoints.
People in both the CBT and the TAU-only groups were seen to initially have similar scores (about 21 in both groups) on the Hamilton Depression Rating Scale, which measures depression (lower scores indicate milder depression; scores of 0 to 7 are considered normal).
After the initial intervention, scores in the CBT group decreased, while score in the TAU group did not change (14.44 vs. 21.33). This difference persisted after the six months of follow-up (scores of 15.37 CTU and 20.53 TAU group). Another measurement of depression, the Beck Depression Inventory, yielded similar results.
The Hamilton Anxiety Rating Scale (which measures anxiety on a rising-severity scale of 0 to 56) showed similar differences: 16.48 in the CBT and 19.88 TAU group immediately after treatment, and 16.51 vs. 18.91 after the six-month follow-up.
Quality of life, which was measured with the Medical Outcomes Survey Short Form–36, was also significantly better (higher scores) in the CBT group, both immediately after CBT (42.54 vs. 38.06) and after six months (41.37 vs. 36.66).
“These results are exciting because they show that specialized therapy significantly improves depression, anxiety and quality of life in people with Parkinson’s disease and also that these results last for at least six months,” Dobkin said in a separate press release put out by the American Academy of Neurology.
Notably, the above scores are averages taking the two groups as a whole. People in these groups were also looked at individually to see how many met pre-defined criteria for a treatment-response threshold of depression “much improved” following the trial. In total, 15 (41%) people in the CBT group met this threshold, while none in the TAU group did.
It should be noted that this study had a relatively small sample size, so further research is needed to replicate its results.
“While preliminary, these findings support the promise of telemedicine to expand the reach of evidence-based, PD-informed depression treatment, and its substantial benefits for PD self-management, into routine neurologic care,” the researchers wrote.
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