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Technology’s Evolving Role in Depression

Jul 18, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Brianna Belton, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

A high percentage of people with diabetes also suffer from depression, and professionals need to be aware of things that they can do to help. Through tech like the SOLVD mobile app, everyday cellphones can help to track symptoms of depression in our loved ones. 

Major Depressive Disorder (MDD), also known as depression, is a common, severe, and debilitating mood disorder. It causes severe symptoms that persistently lead to feelings of hopelessness, fatigue, worthlessness, guilt, failure, and suicidality. The cause of depression is not entirely understood, but it is believed that the neurotransmitters serotonin, norepinephrine, glutamate, acetylcholine, dopamine, and epinephrine are involved. Diagnosis and treatment can be tricky since providers are not able to measure the neurotransmitter levels in the brain. Therefore, the diagnosis is based on patient symptoms. The Hamilton Depression Rating Scale (HAM-D) is a commonly used tool to assess depression. Other assessment tools include the Patient Health Questionnaire (PHQ-9) and the Montgomery-Asberg Depression Rating Scale (MADRS).

Technology today is more significant than ever before. Advancing technology changes the way we communicate, make purchases, find information, and more. Technology also allows us to have portable devices like smartphones, smartwatches, and tablets. This portability increases accessibility and makes a lot of things easier. Additionally, technology has advanced to help people manage chronic conditions like diabetes. However, even with all of the advancements, there is currently no effective method for continuously tracking a patient’s mental health status.

A potential solution to depression is the development of the smartphone- and OnLine-usage-based eValuation for Depression (SOLVD) mobile application. This tool is designed to monitor a patient’s depression state continuously. In this study, three types of data were collected from patients diagnosed with MDD: (1) self-reported mood and activity level daily and the evaluations from the parents of teens; (2) passive smartphone sensor and usage data; and (3) psychometric data from biweekly in-clinic exams (PHQ-9, HAM-D, and HAM-A). HAM-A (Hamilton Anxiety Rating Scale) is used to measure the severity of anxiety based on symptoms; it was used in the patients who also had an anxiety disorder. Two single-arm clinical trials included 22 adults and 13 adolescents with MDD. Each subject was enrolled for two months.

In both studies, there was a significant correlation between self-evaluated mood and their scores from the psychometric data (|r| > 0.5, p < 0.05). The higher the severity of depression, the higher the correlation coefficients. The daily steps are taken; SMS frequency and average call duration were also correlated with the scores. A decrease in the daily steps taken, decreased SMS and phone call frequency, shorter text message length, and shorter phone call duration were predictive of higher depression symptoms.

Two common symptoms found in depressed patients are marked diminished interest or pleasure in all, or almost all, activities, as well as fatigue or lack of energy. Therefore, it is useful to assess the patients based on typical symptoms used in diagnosing patients with depression. Recognizing symptoms is the first step to treating depression.

Due to the correlation being greater with greater severity, this app may also become a valuable tool for determining the severity of depression. For practitioners, this app could become a useful adjunct to developing a personalized treatment for the patients. The study also included adolescents, which is essential to make the app relatable to the real world. A person of any age could be dealing with depression.

SOLVD mobile app was found to be a possible way to monitor depressive symptoms that patients did not perceive as intrusive. The data gathered from the app can help to guide treatment and also allows patients to receive support from their family and friends. Additionally, once the parents or peers of those with depression recognize that their loved ones have higher depression symptoms, the support system should know what actions to take. If SOLVD were to become something that is widely used, it would be essential to include solutions to the symptoms along with the instructions on how to use the app.

Practice Pearls:

  • Technology is continually advancing and has shown to be successful in managing many chronic conditions.
  • Based on the data collected from the SOLVD mobile app, cellphone usage, and the number of steps walked were highly correlated with the symptoms of depression, with data being more pronounced with increasing severity of depression.
  • The SOLVD mobile app could potentially help with tracking patients with depression. When more depressive symptoms are present, personalized interventions can be done to help the patient. 

Moukaddam, Nidal, et al. “Findings from a Trial of the Smartphone and OnLine Usage-Based EValuation for Depression (SOLVD) Application.” Journal of Psychiatric Practice, vol. 25, no. 5, 2019, pp. 365–373., doi:10.1097/pra.0000000000000420.

Truong, Anh L., et al. “3.39 Smartphone and Online Usage-Based Evaluation in Teens (SOLVD-Teen): Can an App Help Teens and Their Parents with Depression?” Journal of the American Academy of Child & Adolescent Psychiatry, vol. 56, no. 10, 2017, doi:10.1016

Brianna Belton, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences