ENCODE: online CBT eases epilepsy-related depression

  • Meyer B & al.
  • Epilepsia
  • 25 Feb 2019

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • An electronically delivered cognitive behavioral therapy (CBT; Emyna) tailored to the needs of people with epilepsy alleviated symptoms of depression.

Why this matters

Key results

  • In intention-to-treat analyses at 3 months, benefit of intervention over usual care:
    • Patient Health Questionnaire-9 (Cohen d, 0.54; P<.001>
    • Neurological Disorders Depression Inventory for Epilepsy (Cohen d, 0.51; P<.001>
  • Similar findings in per protocol analysis.
  • Intervention group also had significantly greater improvements in anxiety, stress, social-occupational impairment, epilepsy-related QoL.
  • At 3 months, the intervention group reported fewer:
    • Illness-related days off work (8.56 vs 16.02; P=.040).
    • Days hospitalized over the preceding 3 months (1.67 vs 3.88; P=.031).

Study design

  • Randomized controlled ENCODE trial among 200 patients with epilepsy and depressive disorder, with at least moderate depressive symptoms.
  • Randomization: intervention vs usual care.
  • Intervention: 6 months of access to electronically delivered, epilepsy-tailored CBT with content on depression, stress, anxiety, seizure triggers, auras, lifestyle habits.
  • Main outcome: depressive symptoms at 3 months.
  • Funding: Gaia Group.

Limitations

  • Dropout rate of 23%.
  • Reliance on self‐reported measures.
  • Lack of active control.
  • 9‐month assessment taking place only 3 months after end of program access.

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