April 03, 2020
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Telephone-based CBT significantly improves depression outcomes for patients with Parkinson's disease

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Telephone-based cognitive behavioral therapy, or T-CBT, reduced depressive symptoms among patients with Parkinson’s disease, according to results of a randomized controlled trial published in Neurology.

“Depression affects up to 50% of people with Parkinson’s disease and may occur intermittently throughout the course of illness,” Roseanne D. Dobkin, PhD, of the department of psychiatry at Rutgers Robert Wood Johnson Medical School and a member of the American Academy of Neurology, said in a press release. “Additionally, in many instances, depression is a more significant predictor of quality [of] life than motor disability. Easily accessible and effective depression treatments have the potential to greatly improve people’s lives.”

According to Dobkin and colleagues, depression in Parkinson’s disease often is undertreated, and more than 60% of patients with significant depressive symptoms do not receive treatment. In pilot studies and a prior randomized controlled trial, CBT showed promising results for treating depression in this patient population. However, physical, geographic and workforce barriers often limit access to psychotherapy for Parkinson’s disease. Teleneurology and telemedicine have shown potential to facilitate personalized, neuropsychiatric care for depression in Parkinson’s disease, yet there is no controlled research to confirm this benefit.

To address this research gap, the investigators aimed to determine whether T-CBT can alleviate depressive symptoms in this patient population significantly more than treatment as usual. They randomly assigned 72 individuals with Parkinson’s disease to a 10-session T-CBT intervention plus treatment as usual or treatment as usual only. Participants in the intervention group received tailored T-CBT weekly for 3 months, with the option of continuing the sessions monthly during 6-month follow-up. Using CBT, the investigators targeted negative behaviors, such as social withdrawal and excessive worry, as well as negative thoughts, such as “I have no control” and “I am helpless.” They also trained care partners to help these patients practice healthy habits. At baseline, midtreatment, treatment end, and 1 and 6 months after treatment, blind raters assessed outcomes, and researchers analyzed data through an intent to treat approach.

Dobkin and colleagues found that on all depression, anxiety and quality of life measures, T-CBT outperformed treatment as usual. Hamilton Depression Rating Scale score, which served as the primary outcome, improved significantly with T-CBT compared with treatment as usual by treatment end. Mean improvement from baseline was 0.27 points for treatment as usual vs. 6.53 points for T-CBT (P < 0.0001). Improvements persisted over 6-month follow-up (P < 0.0001). In the T-CBT group only, a reduction in negative thoughts moderated improvements, reflecting treatment target engagement.

“These results are exciting because they show that specialized therapy significantly improves depression, anxiety and quality of life in people with Parkinson’s disease and also that these results last for at least 6 months,” Dobkin said in the release. “[Although] these findings need to be replicated, they also support the promise of telemedicine to expand the reach of specialized treatment to people who live far from services or have difficulty traveling to appointments for other reasons.” – by Joe Gramigna

Disclosures: Dobkin reports a research grant from the Michael J. Fox Foundation for Parkinson’s Research and the Parkinson’s Alliance (Parkinson’s Unity Walk). Please see the study for all other authors’ relevant financial disclosures.