Deprexis is a web-based program that incorporates cognitive behavioral therapy (CBT) and other approaches to treat depression.
The Deprexis program includes 10 modules (introduction, behavioral activation, cognitive modification, lifestyle modification, acceptance & mindfulness, problem solving, childhood experiences, interpersonal skills, positive psychology, dreams and emotion-focused interventions), each designed to be completed in 10-60 minutes. Modules are not presented sequentially, so users can complete the program at their own pace. Modules contain simulated dialogues between the user and program, where participant responses inform tailored content. The dialogue assesses a user’s understanding and experiences with CBT and depression.
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Cognitive Behavioral Therapy (CBT)
Young Adults (18-30)
Effectiveness of a novel integrative online treatment for depression (Deprexis): Randomized controlled trial.
Meyer B, Berger T, Caspar F, Beevers CG, Andersson G, Weiss M. Journal of Medical Internet Research. 2009. 11(2): e15. doi: 10.2196/jmir.1151
Summary: The authors conducted a randomized controlled trial of Deprexis involving German citizens with depression who were recruited via online advertisements and screened by phone. Those meeting criteria for depression (n=396) were randomized to Deprexis or to a waitlist control. Depression, social functioning, satisfaction, and program usage were assessed at baseline, and 9-, 18-, and 27-weeks. Dropout was high; 55% of participants completed the nine-week assessment. In the Deprexis group, 5% of participants never logged into the program and 17% never completed session one. Fewer than 50% of participants completed 3 sessions. Despite high dropout, the Deprexis group demonstrated significantly greater improvement in depressive symptoms than the waitlist control group from baseline to post-intervention (9 weeks). While 25% of participants assigned to Deprexis showed a clinically significant decrease in depressive symptoms, only 1.9% of control group participants showed a significant change in symptoms. Similar results were found with social dysfunction, with the Deprexis group demonstrating significantly greater reductions in social dysfunction than the waitlist control group.
Take Away: For adults with depression, Deprexis decreases depressive symptoms and social dysfunction.
Internet-based treatment of depression: A randomized controlled trial comparing guided with unguided self-help.
Berger T, Hammerli K, Gubser N, Andersson G, Caspar F. Cognitive Behaviour Therapy. 2011. 40(4): 251-266. doi: 10.1080/16506073.2011.616531
Summary: In this randomized controlled trial, researchers evaluated guided and unguided versions of Deprexis. Researchers used newspapers and television to recruit people from Germany and Switzerland meeting diagnostic criteria for depression. Eligible participants (N=76) were randomly assigned to one of three treatment conditions: 1) unguided Deprexis; 2) therapist guided Deprexis; or 3) waitlist control. Participants in the guided Deprexis condition had weekly email contact with a therapist who gave feedback on their program usage and recent mood, but did not use any therapeutic strategies. Participants in the unguided Deprexis condition had no contact with therapists. Participants in the waitlist control received access to the unguided version after 10 weeks. Depression, interpersonal problems, quality of life, and treatment satisfaction were measured at baseline, 10-weeks, and 6-months. At 10-weeks, participants in the guided and unguided Deprexis conditions had significantly greater improvement in depression than the waitlist control. Clinically significant improvement was seen in 44% of the guided Deprexis group, 28% of the unguided Deprexis group, and 4% of the waitlist control group. No between-group differences in depressive symptoms were detected for the guided and unguided Deprexis groups. Improvements in depressive symptoms were maintained across groups.
Take Away: Therapist-guided and unguided versions of Deprexis comparably reduced depression. These improvements appear to be maintained for 6 months after treatment.
A randomized controlled trial of internet-based therapy in depression.
Mortiz S, Schilling L, Hauschildt M, Schroder J, Treszl A. Behaviour Research and Therapy. 2012. 50(7-8): 513-521. doi: 10.1016/j.brat.2012.04.006
Summary: This German study replicated previous randomized controlled trials of Deprexis and tried to improve study retention rates by sending email reminders and offering non-financial incentives. Participants were recruited through the study website and screened for depression. Although verification was not required, the researchers encouraged eligible participants to send in medical records or provide therapist contact information (61 participants did so). All participants (n=210) were randomly assigned to receive Deprexis or to a waitlist control. Depression, quality of life (QOL), self-esteem, and dysfunctional attitudes were measured at baseline and 8-weeks. Participants in both groups received incentives and email reminders to complete study assessments. The majority (82%) of participants completed the study. Although both groups showed improved outcomes at follow-up, improvements were greater for those in the Deprexis group, 24% of the intervention group showed at least a 50% decline in depressive symptoms, versus only 10% of those in the control group. Severity of depression mediated outcomes, such that participants with moderate depression saw the most benefit from Deprexis, whereas those with mild or severe depression had less symptom improvement. Results were comparable regardless of whether participants had verified depression diagnoses.
Take Away: Individuals with moderate depression may benefit most from Deprexis. Email reminders and non-financial incentives improved study retention, but should be examined further as retention aids.
Efficacy of a psychological online intervention for depression in people with epilepsy: A randomized controlled trial.
Schroder J, Bruckner K, Fischer A, et al. Epilepsia. 2014. 55(12): 2069-2076. doi: 10.1111/epi.12833
Summary: Researchers recruited individuals with comorbid depression and epilepsy from a German epilepsy database and German epilepsy forums. Before randomization, participants were screened for epilepsy and depression. Individuals meeting criteria for both diagnoses were randomized to Deprexis or a waitlist control. Depressive symptoms and quality of life were measured at baseline and a nine-week post-intervention follow-up. Initially, most participants met criteria for mild depression. At nine weeks, participants in the Deprexis group experienced greater improvement in depressive symptoms. While there was no difference in overall epilepsy-specific quality of life, participants receiving Deprexis reported having more energy and less fatigue than those in the waitlist control. Although participants were satisfied with the Deprexis program, they wanted the program to cover more epilepsy-related topics.
Take Away: The online intervention demonstrated efficacy for improving mild depression for individuals with comorbid depression and epilepsy.
Effects of an Internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial.
Meyer B, Bierbrodt J, Schroder J, et al. Internet Interventions. 2015. 2(1): 48-59. doi: 10.1016/j.invent.2014.12.003
Summary: This German randomized controlled trial investigated the efficacy of Deprexis for individuals with severe depression. Individuals excluded from an ongoing clinical trial of Deprexis due to severe depression symptomatology were recruited and screened over the phone. Those who continued to meet diagnostic criteria for depression (n=163) were randomized to Deprexis or usual care and completed assessments of depressive symptoms, quality of life (QOL), somatic symptoms, and anxiety at baseline, 3-, and 6-months. Participants who received Deprexis had larger reductions in depressive symptoms than participants who received usual care. These decreases were sustained at 6 months. The Deprexis group also experienced larger improvements in QOL and somatic symptoms, though these changes were smaller than the changes in depression. Antidepressant medications were found to mediate treatment outcomes; that is, Deprexis plus antidepressants led to better treatment outcomes than antidepressants alone or Deprexis alone.
Take Away: Deprexis plus usual care is more effective in improving severe depression than usual care alone, especially in combination with antidepressants.
An online programme to reduce depression in patients with multiple sclerosis: A randomised controlled trial.
Fischer A, Schröder J, Vettorazzi E, et al. Lancet Psychiatry. 2015. 2: 217-223. doi: 10.1016/ S2215-0366(14)00049-2
Summary: Researchers recruited 90 participants with multiple sclerosis who had reported depressive symptoms through online forums and a database of patients at a German multiple sclerosis clinic. Participants were randomized to receive Deprexis or to a waitlist control condition that received Deprexis at study-end. At baseline, 9-weeks (post-intervention), and six-months, participants completed online assessments of depressive symptoms, quality of life (QOL), and fatigue. Thirty-four participants agreed to also complete in-person clinical interviews assessing psychiatric diagnoses and depressive symptomology at each assessment point. There was a significant difference in changes in depressive symptomology from baseline to post-intervention between the intervention and control groups; depressive symptomology decreased in the intervention group and increased in the control group. Additionally, the number of participants in the intervention group who reported depressive symptomology above the cutoff for clinical depression decreased, while the number of participants in the control group who reported symptomology above the cutoff increased. Within the subsample of participants that completed clinical interviews, there was a significantly larger reduction in the intervention group compared to the control group. Participants reported that Deprexis met or exceeded their expectations, but 28% had to force themselves to complete all of the sessions. The intervention group reported a greater improvement in psychological QOL and motor fatigue than the control group between baseline and post-intervention. The interventions group reported lower depressive symptomology at six months than at baseline.
Take Away: Deprexis shows initial effectiveness at treating symptoms of depression among people with multiple sclerosis.
Effects of a psychological internet intervention in the treatment of mild to moderate depressive symptoms: Results of the EVIDENT study, a randomized controlled trial.
Klein JP, Berger T, Schröder J, et al. Psychotherapy and Psychosomatics. 2016. 85: 218-228. doi: 10.1159/000445355
Summary: In this German pragmatic trial of Deprexis, researchers recruited 1,013 people reporting mild to moderate depressive symptoms (5-14 on PHQ-9) using referrals from clinical settings, online depression forums, health insurance companies, and advertisements. Participants were randomized to the intervention group that received Deprexis in addition to treatment as usual (TAU) or to a control group that received TAU only. Intervention participants with PHQ-9 scores between 10 and 14 were given additional feedback and guidance over email. Participants completed assessments of depression severity, health-related quality of life (QOL), well-being, and relationships at baseline, 3- (post-intervention), and 6-months. Researchers also administered clinical interviews assessing depression severity and psychiatric diagnoses to participants at baseline and 3-months. Reported depression severity decreased in both groups between baseline and 6-months, but the reduction in depression severity in the intervention group was significantly greater than that in the control group. Differences in reductions in depressive severity were smaller among participants receiving medication as a part of TAU. There were also statistically significant treatment effects in favor of Deprexis on clinician-rated depression severity, mental health-related QOL, and psychotherapeutic progress.
Take Away: Deprexis shows effectiveness in treating depression severity and improving mental health-related QOL and well-being among people with mild to moderate depressive symptoms.
The EVIDENT Trial: Protocol and rationale of a multicenter randomized controlled trial testing the effectiveness of an online-based psychological intervention. Klein JP, Berger T, Schroder J, Spath C, Meyer B, Caspar F, Lutz W, Greiner W, Hautzinger M, Rose M, Grafe V, Hohagen F, Andersson G, Vettorazzi E, Moritz S. BMC Psychiatry. 2013. 13: 239. PMCID: PMC3850933.
Does recruitment source moderate treatment effectiveness? A subgroup analysis from the EVIDENT study, a randomised controlled trial of an internet intervention for depressive symptoms. Klein JP, Gamon C, Späth C. BMJ Open. 2017. 7(7): e015391. doi: 10.1136/bmjopen-2016-015391
Time to remission from mild to moderate depressive symptoms: One year results from the EVIDENT-study, an RCT of an internet intervention for depression.
Klein JP, Späth C, Schröder J, et al. Behavior Research and Therapy. 2017. 97:154-162. doi: 10.1016/j.brat.2017.07.013
Summary: Researchers administered online assessments of depression severity and clinical interviews assessing psychiatric diagnoses and depression severity to the 1013 participants recruited for the EVIDENT study monthly between the three-month follow-up assessment and 12 months follow-up. Researchers were primarily concerned with the time to remission, defined as a score on the PHQ-9 below five. Participants in the intervention group were more likely to achieve remission over the 12-month study than participants in the control group. It took participants in the intervention group an estimated 9.35 months and the control group 10.09 months to achieve remission. There was a significant interaction between intervention effect and participants antidepressant use, such that, participants in the intervention group who did not take antidepressants benefited more from the intervention relative to participants who took antidepressants. There were no significant interactions for baseline depression severity, psychiatric diagnosis, or receiving other psychiatric treatment.
Take Away: Deprexis shows evidence of improving remission rates over 12 months, especially for those not receiving medication.
Effectiveness of an internet intervention (Deprexis) for depression in a United State adult sample: A parallel-group pragmatic randomized controlled trial.
Beevers CG, Pearson R, Hoffman JS, Foulser A, Shumake J, Meyer B. Journal of Consulting and Clinical Psychology. 2017. 85(4):367-380. doi: 10.1037/ccp0000171
Summary: Researchers used university mailing lists, internet advertisements, and word of mouth to recruit 376 people in the United States with at least moderate levels of depression (at least 10 on Quick Inventory of Depression Symptoms) to participate in a trial evaluating Deprexis. Participants were randomized to receive Deprexis for eight weeks (n=285) or to a wait-list control group (n=91) that would receive Deprexis after eight weeks. Participants were given a voucher to log in to Deprexis on their own for free during their assigned intervention period. All participants completed online assessments of reported depression severity, depression and anxiety symptomology (ill temper, well-being, social anxiety, traumatic intrusions, panic), and impairment from depression and anxiety at baseline and 8 weeks. Additionally, researchers administered clinical interviews of depression severity by phone at each assessment time point. Participants in the control group completed the same assessments after they completed Deprexis. At post-intervention, the intervention group reported lower depression severity compared to control and was significantly more likely to report at least a 50% improvement in depression severity than the control group. The intervention group also experienced significantly lower interviewer-rated depression and was more likely to experience remission than the control group. Significant intervention effects were also observed for well-being, depression-related impairment, ill temper, social anxiety, and panic. When researchers compared the intervention group’s post-intervention results to the waitlist control group’s follow-up results after receiving Deprexis, there were no significant differences between groups in reported depression severity.
Take Away: Deprexis may improve depression severity in adults with at least moderate depression.
Effectiveness of an individually-tailored computerized CBT programme (Deprexis) for depression: A meta-analysis.
Twomey C, Reilly GO, Meyer B. Psychiatry Research. 2017. 256: 371-377. doi: j.psychres.2017.06.081
Summary: Researchers analyzed data from eight randomized controlled trials that evaluated Deprexis among adults with elevated depression symptoms relative to a control group. The primary outcome of interest was Deprexis’ effects on depressive symptomology. There were a total of 2,402 participants in the eight included trials, with sample sizes in individual studies ranging from 76 to 1,013 participants. Analysis indicated the Deprexis was effective for reducing depressive symptoms with a medium effect size. There were no interactions between the intervention effect and whether the intervention was offered with clinical guidance or whether a developer of Deprexis was an author on the study.
Take Away: The randomized clinical trials evaluating Deprexis to date support its effectiveness for depressive symptoms.