People diagnosed with multiple sclerosis who develop bouts of depression may be able to find relief by simply picking up their telephone and connecting with a counselor. A new study from California suggests a form of telephone-based psychotherapy counseling may be beneficial, and may also be the answer for those who fail to make face-to-face meetings with such counselors.¹

The study was published in this month's issue of the journal Archives of General Psychiatry.

Depression is Not Uncommon in MS
As many as 10 percent of people in the general population experience major depressive disorder, the investigators at the University of California at San Francisco wrote. "Depression impacts the ability to perform essential social roles, including work."

In people with MS, depression can show up in a variety of ways, experts point out. These may range from feeling down for a few hours to severe clinical depression that lasts for several months. This condition is also fairly common in people with multiple sclerosis. In fact, some studies suggest clinical depression, the severest form, is more common in people with MS than in the general population, and possibly more so than in people with other chronic conditions. The most effective treatment, experts say, is a combination of psychotherapy and antidepressant medication. Support groups may also be valuable to people with minimal forms of depression.²

Showing Up for Counseling
Though the majority of patients with depression prefer taking part in psychotherapy over being prescribed antidepressant medication, less than half ever make an appointment with a counselor, and nearly half will drop out before the therapy sessions have concluded, wrote the study team.

Barriers that prevent people with depression from receiving psychotherapy, the investigators stated, include physical impairments, transportation problems, the proximity of such counseling services, and a lack of time or financial resources.

A Positive Alternative
However, more than a decade ago, psychotherapy experienced an evolution, offering counseling services to patients over the telephone. This form of therapy evolved in part due to the advent of 900-number counseling services and the increased use of telephone support services by both insurance and medical groups.

Thus, this latest study was an attempt to determine if such telephone-based counseling is effective for people with MS facing depression. "Several studies have shown that telephone-administered cognitive-behavioral therapy is superior to forms of no treatment controls," wrote David Mohr, PhD, an associate professor of Psychiatry and Neurology, and his colleagues.

Is Telephone-Based Psychotherapy Efficacious?
One-hundred twenty-seven patients diagnosed with multiple sclerosis, and who were experiencing depression, were recruited for the study. Each patient was assigned at random into one of two groups receiving two varying forms of telephone-based psychotherapy: cognitive-behavioral therapy or supportive emotion-focused therapy.

The two therapies differ in that the goal of cognitive-behavioral therapy is to "teach skills that help participants manage cognitions and behaviors that contribute to depression, and improve skills in managing stressful life events and interpersonal difficulties," Mohr and his team wrote. In contrast, supportive emotion-focused therapy is aimed at "increasing participants' level of experience of their internal world," they explained.

The patients in the study underwent regular counseling sessions by telephone with a psychologist for a total of 16 weeks. Mohr and his colleagues then followed-up with each patient for one year afterwards.

One Form of Counseling Was Better, At Least at First
During the counseling sessions, the study team found that steady improvements were being made, but those who underwent cognitive-behavioral therapy advanced the greatest. Those in that group had fewer bouts of depressive disorder, and had improvements in clinical depression, as measured by a special ratings scale.

These gains in therapy persisted over the 1-year follow-up period, but during this time, any initial differences in improvement between the two groups vanished, the investigators found.

"This sample of MS patients had impairments that affected their ability to engage in social roles … and the fact that 74 percent of the sample was not in the workforce," Mohr's group wrote. "The use of telephone-administered therapies may also overcome various other barriers in the general population arising from transportation problems, lack of services in the area, child care problems, lack of time, and stigma."

While the findings of this study were definitely positive, Mohr and his team stressed that the real measure of whether telephone-based psychotherapy is beneficial for people with MS facing depression is to compare its effects with those of face-to-face counseling sessions. It's also important to determine if this form of telephone-based intervention also offers an advantage in cases in which people would otherwise fail to show up for their face-to-face sessions. "Such a comparative trial" will be necessary to answer these questions, the research team wrote.

1. Mohr DC, Hart SL, Julian L et al. Telephone-administered psychotherapy for depression. Arch Gen Psychiatry 2005 Sep;62(9):1007-14.
2. National Multiple Sclerosis Society. Emotional Aspects. Available at: http://www.nationalmssociety.org/Sourcebook-Emotional.asp. Accessed September 9, 2005.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.