Tapping into Neuroplasticity Through Digital Therapeutics for MDD

Telehealth practices, due to their unique virtual infrastructure, provide an ideal setting to introduce the use of innovative tools to improve patient outcomes, including digital therapeutics.

In this video, Steven Chan, MD, MBA, FAPA, FAMIA, Psych Congress Steering Committee, explores the field of digital therapeutics for major depressive disorder (MDD) treatment, offering ideas for how prescription apps can help bolster treatment and the questions virtual providers should ask before embracing a particular app.

For more expert insights for your virtual practice, visit the Telehealth Excellence Forum right here on Psych Congress Network.

Read the Transcript

Steven Chan, MD, MBA: Hi, I am Steven Chan. I'm a member of the steering committee at Psych Congress, and I'm a Clinical Assistant Professor affiliated with Stanford University.

Psych Congress Network: How does understanding the role of neuroplasticity in major depressive disorder impact the way we approach treatment, especially in the context of digital therapeutics? And how does this affect patient outcomes?

Dr Chan: Well, with neuroplasticity and major depressive disorder, we can see that activities and the environment and stimuli can affect the way the disease is progressing. One of the highlights of digital therapeutics is that you can have these apps potentially cue someone to do new behaviors or new habits. But the specific digital therapeutic must have behaviors that the patient would enjoy or that the patient's willing to do. So, one of the things to watch out for with digital therapeutics is whether it is  culturally relevant to the patient? Is it something that the patient was willing to engage in using? Is there support for using these digital therapeutics? Because we've seen that with patient outcomes that people tend to engage with digital therapeutics much more with coach assistance or therapist assistance, rather than using the digital therapeutic simply by itself. So those are some of the things we can think about.

When it comes to patient outcomes specifically, we see that a lot of digital therapeutics, when well-designed, can be very, very helpful for taking care of symptoms of depression and anxiety. It just has to be, again, easy to use, it has to be engaging, and it has to be something that, again, the patient's willing to use. The largest barrier, I would say, is engagement.

PCN: How effective are digital therapeutic strategies for major depressive disorder compared to traditional approaches?

Dr Chan: Well, when it comes to digital therapeutics and the goal at standard treatment, I think we have to keep a few things in mind. A lot of times digital therapeutics are based off of behavioral strategies in ways, for instance, like behavioral activation or changing habits. They may incorporate principles of CBT like tracking mood and tracking thoughts as well. There have been a lot fewer studies for digital therapeutics for MDD compared to gold standard cognitive behavioral therapy. CBT, there's been meta- analysis of about 228 randomized trials that shows about a 33% remission rate for CBT itself, with the help of an individual psychotherapist. Whereas with a digital therapeutics, we've seen about 66 trials, far fewer randomized clinical trials, but we are seeing some promise, of course, with digital therapeutics, which have more evidence than your typical mental health app. Those are some of the things that we think about between the two.

The other things you may also want to think about too, of digital therapeutics are, well, one, you'd have to think about the data and the privacy concerns. Who's going to be storing the data and are they able to secure the privacy? With CBT, all you need to do is just ensure that you have a locked room with an individual psychotherapist who can store a lot of the files securely and such. This individual psychotherapist in CBT would also be ideally board certified or be able to be certified in evidence-based psychotherapy. Whereas if you see digital therapeutics, some of these platforms are going through the FDA to get FDA clearance, but there's not necessarily [a single certification or single seal of approval with digital therapeutics. There are ways to evaluate them, this specific category of apps, but at the moment, there's no single certifying body.

Steven Chan, MD, MBA, FAPA, FAMIA, is a member of Stanford Psychiatry’s TechHub Leadership Committee, faculty with the Stanford Addiction Medicine Fellowship, and a clinical educator caring for patients with substance use disorders (SUD) and addictions. Dr Chan is a clinical informaticist, addiction medicine physician, and psychiatrist. He is a clinical associate professor affiliated with the Stanford University School of Medicine, and Immediate Past Chair of the Committee on Innovation at the American Psychiatric Association. He serves on the Board of Directors at Mental Health America. Dr. Chan is a sought-after national speaker whose ideas, thoughts, and research have been featured at Google headquarters, JAMA, Telemedicine and e-Health, JMIR, Wired, PBS, and NPR Ideastream. He serves as Chief Technology Officer and co-founder of AsyncHealth — a University of California-backed digital mental health startup supported by Berkeley SkyDeck PAD-13 and the National Science Foundation Innovation Corps (NSF i-Corps) — and writes at both @stevenchanMD and @mpowerhacks.