A study published in the August 25, 2004, edition of the Journal of the American Medical Association, (JAMA) suggests that counseling by telephone can be a positive addition to antidepressants in reducing the symptoms of depression.

In an 18-month study conducted in Seattle, Washington, researchers found that they could significantly increase recovery rates for patients taking antidepressants by providing several counseling sessions over the phone. Previous studies have shown that phone calls from nurses or other staff members could help people trying to quit smoking or stay on medication. The Seattle study is the first to test the effect of cognitive behavioral therapy (CBT) delivered entirely over the phone. It is not clear from the study whether phone counseling will be equally helpful for everyone with depression.

According to Dr. Gregory Simon, the study’s lead researcher, “We don’t think that the telephone is somehow better than traditional psychotherapy. In fact, in-person is probably more powerful. But this outreach was to people who wouldn’t come in otherwise, and the telephone therapy got dramatically better results than for those who received no therapy.” Simon is a psychiatrist with the Seattle-based Group Health Cooperative, a consumer-run, nonprofit health care system, with more than 500,000 members.

The researchers followed 600 men and women receiving antidepressant treatment in Group Health clinics. The patients were randomly assigned to one of three treatment plans: usual care, in which they were simply instructed to follow their prescription; telephone management, in which they received two phone calls and a mailer with advice and support for continuing the prescription; and phone therapy, in which trained therapists provided up to eight sessions on how to combat the negative thinking that accompanies depression. The participants in this group also had workbooks that reinforced the phone therapy and were encouraged to do homework between sessions.

By the end of the study, 80 percent of those who had received phone therapy said their depression was “much improved,” compared with 55 percent of those who were given usual care and were prescribed antidepressants. Of those who received encouragement by phone but not explicit therapy, 66 percent said they were “much improved.” According to the study, the researchers do not know what component of the phone therapy made it effective or whether the increased attention itself made patients feel better. But for therapists trying to treat patients who are hard to reach, the study may provide an alternative to in-person care. This type of therapy could prove invaluable in rural and underserved areas, where stigma can be a barrier to treatment and where there is a lack of adequately trained mental health professionals.