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While people with mild to severe depression languish on wait lists to see a therapist in the U.S. and Canada, perhaps Internet apps offering self-guided cognitive behavioral therapy could be of help.

But how useful are they and are they appropriate for all levels of depression?

The research looks promising.

A new study, recently published in the Journal of Medical Internet Research, took a look at 21 previous studies on Internet apps delivering iCBT or internet-based cognitive behavioral therapy and found that they were effective for people suffering from mild, moderate and severe depression.

“This study was a meta-analysis (which is a quantitative or numerical review) of studies that explored the efficacy of a type of Internet-based therapy for depression,” study author, Lorenzo Lorenzo-Luaces told us. Lorenzo-Luaces is a clinical professor in the IU Bloomington College of Arts and Sciences' Department of Psychological and Brain Sciences. “What I was interested in was the types of patients who were studied and whether the study looked like it worked because it excluded patients who were more ‘difficult’ to treat (e.g., who were more severe, or more suicidal, or used alcohol or drug). I definitively thought that, for safety reasons as well as for the sake of ‘proving’ the treatment worked, that many of these patients would have been excluded.”

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), someone might have major depressive disorder if they are suffering from a depressed mood for at least two weeks. Symptoms of major depressive disorder can include loss of appetite, low energy, fatigue, concentration difficulties, trouble sleeping and thoughts of suicide.

Lorenzo-Luaces says he chose to study iCBT because depression is a serious health problem. Officially, 1 in 5 adults will meet the criteria for depression. Most people have a tough time accessing treatments and iCBTs have become very popular as a result. However, Lorenzo-Luaces explains, we know from the literature on face-to-face therapy and antidepressant medications that if you only study specific groups of patients you get a very biased kind of view of how effective a treatment is.

“My co-authors were an undergraduate from my home institution, Emily Johns, and a former graduate school peer, Jack Keefe. We used a review that had been recently published by an excellent Dutch group led by Eirini Karyotaki and Pim Cuijpers,” Lorenzo-Luces told us. “We updated it up to the present date, then we carefully read each study and coded it for whether specific criteria had been used. We analyzed the data to understand if there were differences between studies which reported vs. did not report different exclusion criteria. We also compared the rates for using different criteria versus what we know to be done in studies of face-to-face therapy and antidepressants.”

According to the World Health Organization, over 300 million people suffer from depression. In the U.S., over six per cent of adults have experienced major depression in the past year.

“We already knew from past work that the iCBT platforms were effective,” Lorenzo-Luaces told us. “What was surprising was that, overall, they were less, rather than more, likely to exclude patients with conditions known to worsen depression than studies of antidepressants or face-to-face psychotherapy. What’s more, when the studies did use specific exclusionary criteria, it didn’t affect the results!”

Depression and anxiety are closely related, in fact anxiety is the most common mental illness in the U.S. If you have been diagnosed with depression, you have a 50 per cent change that you will also be diagnosed with anxiety.

The researchers were surprised with the results of their study.

“Not a single study excluded a patient with a personality disorder,” Lorenzo-Luaces told us. “The exclusions for substance use disorder, which are the norm in studies of face-to-face therapy of studies of antidepressants, were used very infrequently.”

Most people who suffer from depression begin to experience symptoms between the ages of 18 and 25. Studies have found that at some point in their lives, 15 per cent of adults will suffer from depression.

“I think the field (e.g., psychologists, psychiatrists, family doctors, social workers) needs to think more seriously that many people can benefit from treatments that we sometimes consider ‘unconventional’ because they are not medications or face-to-face therapy,” Lorenzo-Luaces told us. “The data are clear, these therapies (e.g., iCBT, psychoeducational groups) can work for a lot of people.”

Despite the positive results, researchers add a word of caution.

“This does not mean that people should stop all their treatments and download the latest app they see a commercial for,” Lorenzo-Luaces told us. “Nor does it say that every online application is likely to be helpful. Some programs have a lot of research evidence behind them. For example, the Deprexis online platform has been tested in at least eight different clinical trials that combined tested 2402 patients. I see other ads on Facebook or online for apps that have never been tested and some of those are probably just a waste of time.”