Having a 'therapist in your pocket' curbs depression among primary care patients

Patients with depression who received the Moodivate app saw clinically meaningful reductions in their symptoms that were twice those achieved with standard-of-care therapy in a clinical trial conducted at 22 primary care practices in Charleston, South Carolina. App users were also 3 times more likely to achieve a clinically meaningful improvement in their depression and  2.3 times more likely to attain depression remission. Moodivate (available on both iOS and Android)  is a digital version of behavioral activation, a type of behavioral therapy that has proved effective against depression. Jennifer Dahne, Ph.D., professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, came up with the idea for the app while at another institution and has continued to develop it at MUSC.  Moodivate is self-directed, meaning that the involvement of a therapist is not required, making it more scalable and cost-effective for reaching primary care patients. Dahne and her team reported their findings in the Journal of the American Medical Association (JAMA) Internal Medicine.

Depression is the leading cause of disability worldwide, according to the World Health Organization. In 2021, 21 million Americans experienced a bout of major depression; younger adults, ages 18 to 25, were the hardest hit, with nearly 1 in 5 affected. Dahne believes that primary care offers the best opportunity to address depression at the scale required to make a dent in those numbers, especially since most practices already screen for depression.

“Primary care providers are absolutely on the frontlines of identifying and treating depression in this country,” said Dahne. “It’s wonderful that they are screening patients for depression, but the downside is that they have very few treatment resources at their disposal, other than medications, to help with depression management.”

Primary care physicians can refer patients to mental health providers, who can provide non-pharmaceutical therapies, such as behavioral activation, which have been proved effective. However, wait times for these services can be long, and, once treatment has begun, it is often not at a frequency needed to be effective. Unfortunately, demand for this therapy outstrips supply, and therapists often do not have the bandwidth to meet patients at the weekly intervals needed to be optimally effective.

Behavioral activation therapists encourage patients to engage in activities that they enjoy or find meaningful to boost their mood.

“With behavioral activation, we help a patient to change what they're doing to change how they're feeling,” said Dahne. “Patients often think they can’t do something new or different until they feel better. An early goal of treatment is to change that perception and help patients to realize that their mood is influenced by what they do in their day-to-day lives.”

In behavioral activation, therapists work with patients to identify their goals and the daily activities they will need to engage in to achieve them, even helping them to schedule and track these activities.

To improve access to behavioral activation therapy, Dahne created the Moodivate app to walk patients through goal setting and activity identification, scheduling and tracking without the involvement of a therapist. In addition to these functions, Moodivate can send reminders to complete daily activities and award digital badges as patients hit milestones to improve motivation. Patients also self-report regularly about changes in their depressive symptoms.

In the trial conducted by Dahne involving 649 primary care patients, with funding from the National Institute of Mental Health, those using the Moodivate app were 3 times more likely to experience a clinically meaningful improvement in depression and 2.3 times more likely to achieve remission. These results were particularly impressive, said Dahne, explaining that more than 80% of the patients who enrolled in the study were currently taking medications for mental health, and most of those had been taking them for more than four years.

Dahne hopes the app will be adopted widely, helping those with depression not only to reduce depressive symptoms in the present but also to develop resilience for the future.

“The app is like a therapist in your pocket,” said Dahne. “It helps patients to develop this new skill set. When they’re feeling down, they can change what they are doing in their day-to-day lives, knowing from experience that these changes can help to improve their mood. The hope is that access to the app will help with long-term recovery.”

Now that Moodivate has proved effective in a clinical trial aimed at treating depression in primary care patients, Dahne is looking for broad partnerships with health care institutions, insurance companies and corporate wellness programs that will allow the app to be rolled out to more patients. She also hopes to make the app available to specialized populations with high rates of depression, such as patients with advanced or metastatic cancer.

“I'm very interested in taking Moodivate and expanding it to address depression treatment gaps within other patient populations at MUSC and beyond,” she said.

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The National Institute of Mental Health had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and the decision to submit the manuscript for publication.

 About the Medical University of South Carolina

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