Internet-based treatment for depression in multiple sclerosis: A randomized controlled trial.
BACKGROUND
Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitations impede face-to-face treatment. Internet-based treatment is therefore a promising tool for treating depression in MS.


OBJECTIVE
To investigate effectiveness of a guided Internet-based problem-solving treatment (IPST) for depressed MS patients.


METHODS
MS patients with moderate or severe depressive symptoms were randomly assigned to IPST or a wait list control. Primary outcome was the change in depressive symptoms defined by a change in sum score on the Beck Depression Inventory Second Edition (BDI-II). Assessments took place at baseline (T0), within a week after the intervention (T1), and at 4 months follow-up (T2). Analyses were based on the intention-to-treat principle.


RESULTS
A total of 171 patients were randomized to IPST ( n = 85) or a wait list control ( n = 86). T1 was completed by 152 (89%) and T2 by 131 patients (77%). The IPST group and wait list control showed large significant improvements in depressive symptoms, but no differences were found between groups at T1 ( d = 0.23; 95% confidence interval (CI) = (-4.03, 1.08); p = 0.259) and T2 ( d = 0.01; 95% CI = (-2.80, 2.98); p = 0.953).


CONCLUSIONS
We found no indication that IPST for MS patients with moderate or severe depression is effective in reducing depressive symptoms compared to a waiting list. Large improvements in the wait list control were unexpected and are discussed.
EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands.
Rosa E
RE
Boeschoten
Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands/EMGO+ Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, The Netherlands.
Joost
J
Dekker
Department of Neurology, Multiple Sclerosis Center, VU University Medical Center, Amsterdam, The Netherlands.
Bernard Mj
BM
Uitdehaag
EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands.
Aartjan Tf
AT
Beekman
EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands.
Adriaan W
AW
Hoogendoorn
Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
Emma H
EH
Collette
EMGO+ Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands/Department of Clinical, Neuro & Developmental Psychology, VU University, Amsterdam, The Netherlands.
Pim
P
Cuijpers
EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands.
Magdalena M
MM
Nieuwenhuis
EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands.
Patricia
P
van Oppen
D000328:Adult; D003863:Depression / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D011340:Problem Solving; D016896:Treatment Outcome
Depression; Internet-based treatment; clinical trial; multiple sclerosis; problem-solving treatment