In order to test whether phone therapy is helpful as an adjunct to anti-depressant medication, researchers enrolled 600 depressed outpatients in a randomized trial. All patients were started on antidepressants as agreed upon by physician and patient—the researchers did not control or conceal the medication or dosage. Patients were then randomly assigned to: a) “care management,” consisting of brief tele- phone and mail contact to improve antidepressant adherence; b) telephone cognitive-behavioral therapy (nine half-hour sessions) + care management; c) usual care, which includ- ed both treatment in primary care and referrals to mental health specialty care. Among the 89% of patients who remained in the study after six months, the rates of antidepres- sant treatment response were 51% (care management), 58% (phone therapy), and 43% (usual care). Phone therapy was sta- tistically significantly more effective than usual care and was associated with 46 more depression free-days over two years (Simon GE et al., JAMA 2004;292:935-942). In terms of cost- effectiveness, phone therapy was associated with a cost of $9 per additional depression-free day, while care management was significantly more expensive, at about $24 per depression-free day (Simon GE, Arch Gen Psychiatry 2009;66:1081-1089).
TCPR's Take: Adding nine half-hour sessions of tele- phone cognitive behavior therapy to antidepressant medications appears to be both efficacious and cost-effective. But the practicality of phone therapy hinges on whether insurance companies will pay for it, because clinicians are not going to provide it for free and not all patients can afford the out of pocket expense. In addition, it would be helpful to see a similar study testing the effectiveness of supportive phone therapy, since supportive techniques are mastered by far more clinicians than CBT
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