An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial

Abstract

Summary
Background With a lifetime risk for major depressive disorder of up to 50%, depression is a common comorbidity in
multiple sclerosis but remains widely underdiagnosed and untreated. We investigated the potential of a fully
automated, internet-based, cognitive behavioural therapy programme, Deprexis, to reduce depressive symptoms in
patients with multiple sclerosis.
Methods For this randomised controlled trial, we recruited patients from an outpatient clinic in Hamburg, Germany.
Patients aged 18–65 years were eligible for inclusion if they had multiple sclerosis and self-reported depressive
symptoms. By use of a computer-generated randomisation sequence, we allocated 90 patients (1:1; no blocking or
stratification) to either the intervention group or a waitlist control group for 9 weeks. The primary endpoint was the
Beck Depression Inventory (BDI), as assessed by an intention-to-treat analysis. This trial is registered with
ClinicalTrials.gov, number NCT01663649.
Findings 71 patients completed the trial: 35 patients in the intervention group and 36 patients in the control group.
During the intervention, BDI scores decreased in the Deprexis group and increased in the control group, yielding a
positive effect of Deprexis relative to the waitlist group (mean group difference –4·02 points [95% CI –7·26 to –0·79],
p=0·015, effect size d=0·53). Worsening of depressive symptoms from below to above the clinical cutoff (BDI >13)
occurred in three (7%) of 45 patients in the control group and no patients in the Deprexis group. We noted no adverse
events with respect to new occurrence of suicidal ideation during the trial.
Interpretation Psychological online-intervention programmes could be suitable for patients with multiple sclerosis
who are unable to regularly attend therapeutic sessions because of mobility impairments.
Funding European Union and the Deutsche Forschungsgemeinschaft.