After performing major heart surgery to repair an aneurysm and a triple bypass in June 2016, doctors told David McGee’s wife that he “wasn’t worth 5 cents,” says the 65-year-old clockmaker and locksmith from Pittsburgh. He was not expected to survive. He did, but like many heart disease patients, he slipped into a deep depression. McGee wasn’t the type of person to reach out for mental health treatment. But thanks to new technology, his health care plan reached out to him.
McGee’s plan, Highmark Insurance, uses a cloud-based software platform called Quartet that reviews medical records to target patients at risk for mental illness, then links them to appropriate care, including in-person therapy and teletherapy. Primary care providers work with Quartet’s network of behavioral health specialists through the digital platform. “I was impressed they called me,” McGee says. A counselor followed up once a week to talk to him and his wife, who he credits with helping push him during his recovery. “We talked about a lot of stuff,” he says. “Their input makes you feel different when you’re done with the conversation.”
This is one of an explosion of new digital tools entering the market to help diagnose and treat depression and other mental illnesses. And these advancements are making an enormous difference in both psychiatric care and general medical care. “Any of the important chronic diseases of today are made worse when depression is present,” says Ellen Frank, professor emeritus of psychiatry and psychology at the University of Pittsburgh Medical School. “So if we can tell who is getting depressed and who is getting better, that has enormous potential for both improving quality of life and lowering health system costs.”
[Read: Is Depression a Disease?]
24/7 Data
Many of these online tools are connected directly to patients through their cellphones or, increasingly, digital wearables like the iWatch. Wearables are, so far, problematic. “The data suggest that patient adherence falls off quickly between two and three months,” Frank says. “They put it in [a] drawer and don’t take it out again.” Phones, however, are an almost permanent fixture in everyone’s pocket or handbag. They can be outfitted with sensors that can collect and transmit real-time data on the person’s physical markers like heart rate and respiration, where the person is (out socializing or home for days on end), how much he or she is exercising and even whether someone is making cognitive mistakes while, say, driving or typing, says Frank, who is the chief scientific officer for HealthRhythms, an app that does just this sort of thing. Some apps can use Wi-Fi to send an alert if, for example, a patient for whom alcohol is a risk is going into a bar. Others are being developed to read voice changes, which can offer clues to how people are feeling.
Mental health professionals can use phones, laptops or tablets to conduct simple patient surveys in real time, adds Dr. John Torous, co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center, which is affiliated with Harvard Medical School, where he serves as a staff psychiatrist and clinical informatics fellow. “We usually ask people to tell us how they feel, and that is still important, but we can now learn that information from their phone [or other device],” he says. “Memories can be subjective, but with real-time surveys, when people come to the clinic we know exactly how they were sleeping, eating and feeling.”
Many research groups are creating and investing in web-based interventions to treat a range of disorders, some based on psychotherapies such as cognitive behavioral therapy. Some have coaches for patients to work with personally. “There is even some high-flying technology with Apple’s new iPhone X, with the capacity for facial recognition,” says Frank. “Changes in facial mobility and expression seem to indicate depression.” Such facial recognition analysis hasn’t become practical yet –but it will.
[Read: How Do I Know If I Have Depression?]
Buyer Beware With Digital Assistance
With about 10,000 mental health-related commercial apps available, the American Psychiatric Association has formed a work group to provide guidance on their efficacy. “It would be nice to score or rate them, but we realized they are always updating and changing, like all apps, and in a few months the reviews are out of date,” says Torous, who chairs the APA work group. They can, however, help people ask the right questions:
— Does the app have a privacy policy? “That sounds obvious, but many don’t,” he says. “They exist outside HIPAA laws, and if your personal information is not protected, the company can do whatever it wants with these data.”
— Is the app evidence-based? “We have found [apps] that suggest drinking alcohol when in a manic state is helpful, and that is just ludicrous,” Torous says. “There is no quality check for many of these, so be sure the app is not harmful and not wasting your time.”
— Is the app easy to use? There is evidence that many people download an app but don’t use it more than a week, says Torous, who is involved in creating an app to help researchers analyze data on cognition. “There is not much literature on these apps, and it is hard to know how effective they will be, especially over the long term. They seem to be useful for some, but they are not a panacea.”
[See: Am I Just Sad — or Actually Depressed?]
Despite the warnings, both Frank and Torous believe that digital help is valuable, especially for those who won’t otherwise seek treatment. “From my own experience, so many people with depression are not receiving any kind of intervention, either because it is not available near them or because a stigma still remains,” Frank says. “So my feeling is, I am yet to see the mobile or web intervention that is worse than nothing.”
And while much of this technology is not simple to use, it’s improving. “We are in a transition phase right now, moving to a point where the technology is easy,” Torous says. “Within five years, it will be a large part of the arsenal of all mental health professionals, and in a decade it will be one of most important tools we have.”
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What High-Tech Tools Are Available to Fight Depression? originally appeared on usnews.com