Effectiveness of a tailored, integrative Internet intervention (deprexis) for depression: Updated meta-analysis

Abstract

Digitally delivered interventions for depression vary in many aspects, including their therapeutic orientation, depth of content, interactivity, individual tailoring, inclusion of multimedia, cost, and effectiveness. However, their effectiveness is rarely examined in intervention-specific meta-analyses. An earlier meta-analysis of eight randomized controlled trials (RCT) demonstrated the effectiveness of a tailored, integrative digital intervention (deprexis), which is delivered via the Internet. This updated meta-analysis of twelve deprexis-specific RCT with a total of N = 2901 participants confirmed the effectiveness of deprexis for depression reduction at post-intervention (g = 0.51, 95% CI: 0.40-0.62, I 2 = 26%). Results were analogous when study quality, screening and randomization procedure were taken into account. Clinician guidance, developer-involvement, setting (community vs. clinical), and initial symptom severity did not have statistically significant effects on the effect size, and there was no evidence of publication bias. Thus, these findings demonstrate that deprexis can facilitate clinically relevant reduction of depressive symptoms over 8-12 weeks across a broad range of initial symptom severity, and that the intervention can be combined with other forms of depression treatment. There is now a need to study the intervention's implementation in routine care settings as well as its long-term effectiveness and cost-effectiveness in diverse cultural and linguistic settings.Funding: Funding Statement: Gaia AG, Hamburg, provided support in the form of salaries for authors [B.M. and O.B.], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the Despite such encouraging findings, caution is warranted for several reasons, and sweeping conclusions suggesting that all Internet interventions for depression are effective would be misguided. Of note, meta-analytic evidence showing that such interventions are effective on average does not mean that these interventions are all equally effective or, indeed, that any one intervention is effective at all. Internet interventions for depression differ substantially in their accessibility, therapeutic orientation, depth of content, interactivity, individual tailoring, inclusion of multimedia, self-monitoring tools, homework assignments, and cost [4]. Worryingly, many such interventions for depression are not evidence-based because they are never evaluated in randomized clinical trials (RCTs); this was the case for 20 out of 32 identified programs in a recent review [4].Given this substantial heterogeneity among Internet interventions for depression, one might expect that they also differ in terms of their effectiveness, although head-to-head trials are rare. In one large trial that included two Internet interventions for depression (Beating the Blues and MoodGYM), neither of them was effective when added to primary care in the United Kingdom [5]. A recent meta-analysis of self-guided depressio...

Availability of internet-based cognitive behavioral therapies (iCBTs) for depression: A systematic review

“…"Deprexis," requires a prescription from a clinician and therefore is not accessible to the average consumer. The program has been so widely-studied that it has its own meta-analysis, which documents the intervention's efficacy (Twomey et al, 2020). It has been translated into nine languages but is only available in select countries within Latin America, Europe, and Asia, excluding North America.…”

Effectiveness of an internet-based self-guided program to treat depression in a sample of Brazilian users: a study protocol

“…This rate has been achieved in several prior clinical trials with Deprexis. 48 Based on previous research, 29,35,42,47,48 predicting a moderate effect size seems realistic. This calculation is based on the assumption that a 50:50 randomization procedure will be used.…”

“…For example, a meta-analysis of a specific Internet intervention for depression (Deprexis) reported large effect sizes averaging d = 0.54, based on eight randomized controlled trials conducted in German-speaking countries and the United States. 35 In Brazil, the Federal Council of Psychology regulates the Internet-mediated psychological practice with Resolution 011/2018. 36 In this document, Brazilian psychologists are authorized to provide treatment through online services such as Skype ® , FaceTime ® , and text services (e-mail, chat applications, messaging, etc.).…”

“…37 Deprexis (https://deprexis.broca.io/en/) is an established online intervention for depression that has already been tested in 12 randomized controlled trials. 35,[38][39][40][41] Deprexis uses an integrative approach, based primarily on cognitive behavioral therapy. 42 Evidence for the effectiveness of this program has been reported in Europe, especially German-speaking countries 29,[42][43][44][45][46][47] , as well as in the United States.…”

Feasibility, effectiveness and safety of the self-management intervention deprexis in routine medical care: Results of an uncontrolled observational study

“…One SMI that has been studied in numerous trials, is deprexis®24 (hereafter “deprexis”, for a meta-analysis, see Twomey et al, 2020 ). In these trials, this SMI has demonstrated its effectiveness not only in mild to moderate depression ( Klein et al, 2016 ) but also in severe depression ( Meyer et al, 2015 ).…”