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Pat Thomas

Try This App and Call Me in the Morning

By Pat Thomas, 15/10/15 Articles
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You know the old joke.

When a doctor doesn’t know what to do he or she says “take two aspirin and call me in the morning”. The very act of prescribing something simple is thought to be, at the very least, benign and at best may produce a placebo effect that makes the patient’s problem go away without further intervention.

This week a new study emerged which gave me pause because it highlighted the problems of a hi-tech equivalent of the aspirin prescription – the health app.

Specifically, the study found that there is no proof that 85% of the phone apps currently recommended by the NHS for patients to manage their depression actually work.

Waiting too long

According to the experts writing in the journal Evidence Based Mental Health an NHS recommendation for an app may falsely reassure patients, many of whom are increasingly opting to fund their own treatment in the face of overstretched mental health services and the associated lengthy waits.

The statistics are dire. One in 10 patients with mental health issues in England is now waiting more than a year before getting any form of treatment, and one in two waits more than three months.

One in six of those waiting for treatment is expected to attempt suicide, while four in 10 is expected to self-harm and their condition is likely to worsen in two thirds of those waiting to see a mental health professional.

Interactive online and app based treatments for mental health are becoming increasingly popular and accessible as a result of the growth in routine use of smartphones and tablets. This makes them an attractive proposition for a cash- and time-strapped NHS.

At least in the abstract.

Where’s the evidence?

The reality is different. For instance, in 2013, there were only 32 published articles on apps for depression, one of the most common mental health conditions, despite the availability of more than 1500 for download.

And it doesn’t matter if an app has been given the NHS seal of approval: of the 27 mental health apps currently listed in the NHS library, 14 are for depression and anxiety. Yet only four provide any scientific proof that they work when used by patients, and only two of them have been properly evaluated for clinical effectiveness.

These apps aren’t just a waste of money, they could actually make depression worse for some.

Because of this the researchers recommend that any app can’t demonstrate evidence of effectiveness it should be removed from the NHS app library. Well duh!

Increasing disconnection

But isn’t there also something rather sad about doctors telling patients with depression to check out the latest app? People who are feeling depressed often feel very disconnected from others. This is why talking cures have consistently proved to be clinically as effective as pills in treating depression and anxiety. And some would argue that because talking cures don’t come with the raft of adverse effects that pills do they should be considered more effective.

In spite of the language around social media – for instance the idea that it ‘connects’ us to ‘friends’ – social isolation is a growing problem for many.  Social media is unlikely to help. In fact, in 2013 a major study found that Facebook use worsened how people feel moment-to-moment and how satisfied they are with their lives.

The need for better care

Depression is a recurrent disorder. It affects an estimated 350 million people worldwide, and is projected to become the second leading cause of ill health (for instance, long term depression doubles stroke risk) and premature death by 2020. Without ongoing treatment, as many as four out of five people with depression relapse at some point. More than half of people with severe depression do not respond to antidepressant treatments.

What is more depression may not all be ‘in the  mind’; depressed individuals tend to have brains that are 30% more inflamed than healthy brains suggesting biological/physiological causes – as yet unidentified – that current treatments don’t even target.

We owe people who are suffering from depression much better and more comprehensive care than telling them to “try a couple of apps and call me in the morning.”