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Self-help books and websites help in severe depression

‘Low intensity’ interventions should be first step in treatment

Louise Prime

Thursday, 28 February 2013

People with depression, even the severely depressed, could try self-help websites and books as a first step in managing their symptoms, suggest primary care researchers. The UK-led study, published on bmj.com, found that more severely depressed people as well as those with lower depression scores benefited from such ‘low-intensity’ interventions.

Researchers conducted a meta-analysis of individual patient data from 16 separate datasets, including 2470 people treated in the community for depression. The severity of their symptoms varied from low level, to moderate to severe.

Patients had been offered low-intensity treatment, often with limited guidance or support from a healthcare professional, to help them to manage their symptoms; this involved using self-help books or interactive websites. Studies involving group therapy were not included in the analysis.

The researchers found that people who were more severely depressed at baseline derived “at least as good clinical benefit from ‘low-intensity’ interventions as [did] less severely ill patients”. But because their symptoms had been more severe initially, many could still not be considered recovered after the intervention, and might need further treatment.

The authors of the study suggest that because baseline severity of depression was not meaningfully related to the benefit derived from low intensity interventions, such treatments could be legitimately included in the first step of a stepped care system – and most patients, even those whose depression is more severe, encouraged to try them as the initial treatment option.

However, they add: “Clearly some patients will not find such interventions useful, and it would seem sensible to continue to refer severe cases to more intense psychological intervention or pharmacological management until further evidence is generated confirming our findings. The current data suggest that the threshold could be relatively high if patients are willing to engage in low intensity interventions.”

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