title: An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial.
abstract: 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Psychological online-intervention programmes could be suitable for patients with multiple sclerosis who are unable to regularly attend therapeutic sessions because of mobility impairments.
  
  
  BACKGROUND
  European Union and the Deutsche Forschungsgemeinschaft.
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Fischer
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Schröder
authors.affiliation: Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Department of Cognitive Psychology, Ruhr-University, Bochum, Germany.
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Wolf
authors.affiliation: Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Pöttgen
authors.affiliation: Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lau
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Heesen
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: stefan.gold@zmnh.uni-hamburg.de.
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Gold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000517:prevention & control*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology* / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D055815:Young Adult