In this blog post, I explain how digital therapeutics are revolutionizing healthcare and medicine as we know it. In particular, I will analyze what this means for depression treatment.

Wide adoption of smartphones in recent years has made rapid uptake of digital therapeutics possible, and, especially when supported by remote healthcare professionals, the results are nothing short of amazing!

First of all, how large of a problem is depression?

Today globally more than 300 million people suffer from depression and it is the leading cause of disability (1). While there are reasonably effective treatments for depression available, there aren’t enough healthcare resources to treat the growing number of people with depression. In 2016 only 23.2% of depression treatment was psychotherapy. Today most patients suffering from depression in the US are treated only with antidepressants (2).

Problem with Antidepressants

While antidepressants can be lifesaving, and truly help people with severe depression, they are not a one size fits all solution. Only around 36% of patients respond to the first prescribed drug they take. As part of standard care today, patients can end up trying a new drug every few months because the initial antidepressant didn’t help with their symptoms. 33% of patients do not reach remission of symptoms even after trying five different antidepressants (3).

A large number of people who never respond to antidepressants still end up dealing with side-effects for years while trying to ease their suffering. Even people who receive an effective antidepressant often have their symptoms come back when they quit taking them. Antidepressants are the number one prescribed drug category in the US because depression is an enormous issue and drugs are readily available.

As a result around 13% or 42 million people in the United States are on antidepressants (4). I know, this sounds bizarre!

Unfortunately, 86% of patients treated with antidepressants get at least one side-effect. These can include bothersome and even serious symptoms like apathy, fatigue, weight gain, sleep disturbances, gastrointestinal problems and sexual dysfunction (5). The first antidepressant prescription is more likely to cause side-effects than help the patient reach remission of symptoms.

While antidepressants are effective for some individuals, there’s definitely a need for safer and more effective solutions, and simply a wider range of options for people to choose from.

Digital Therapeutics: Key to Modern Healthcare

This is where digital therapeutics step in. Digital therapeutics are an emerging healthcare technology and treatment methodology that often also includes support from remote clinicians. Digital therapeutics utilize digital solutions to change patient behavior and lifestyle, usually with the help of a smartphone and delivered through an app. Digital therapeutics have been successfully used to treat many chronic diseases like type II diabetes, obesity, and depression (6).

As mentioned before, one of the factors enabling the emergence of digital therapeutics is smartphone technology and its wide adoption. Smartphones are now in almost everyone’s pocket, and smartphone technology allows much closer interaction with a person/patient than has ever been possible before.

For example, notifications and reminders can reach the patient at any time of day and in connection with specific physical locations. This makes it possible for a patient to get a reminder in the morning to report symptoms, or to get a reminder when arriving home to check blood pressure. Receiving notifications as part of the treatment program increases the intervention’s mind-share in people’s daily life resulting in better adherence and better health outcomes.

Because digital therapeutics are inherently an online and connected intervention, healthcare professionals can efficiently collect and analyze patient data, which in turn is enabling personalized and real-time treatment. Personalized treatment can be very beneficial when dealing with depression because the underlying causes for depression can vary greatly.

By using digital therapeutics, the vast amount of data collected from each patient and their healing journey, allows recognition and learning of important individual factors and patterns. This again allows more customized and individualized care delivery that is more likely to reduce depressive symptoms.

Great design also makes a difference. Nowadays when digital healthcare solutions are more on par with widely adopted consumer applications and services (Google, Facebook, Instagram etc.), we are seeing improved patient adherence. Quality content delivered in a straightforward, beautifully designed user experience can be one of many strengths of digital therapeutic interventions.

Remote Clinician Support as a Key Component

Digital therapeutics can either be standalone (only an app or online material, or sometimes even chat-bot augmented) or supported by a remote healthcare professional (in some cases also health coaches).

This distinction is important because, while standalone digital therapeutics are helpful, the remote clinician support complements the delivery and treatment adherence of digital therapeutics tremendously. Pairing digital therapeutics with a remote clinician improves care accountability. When there is a real person to be accountable to — such as a live therapist who cares for and helps patients reach their best possible outcomes — these solutions become even more motivating and effective.

Several research studies have shown superior adherence to treatment when augmenting digital therapeutics with clinician support vs. when using only standalone digital or computerized treatment programs. (7, 8)

Another fundamental difference to regular health care is frequent communication vs traditional monthly or weekly visits. Digital therapeutic solutions often have built-in messaging platforms similar to Facebook and WhatsApp making communication between patients and remote clinicians feel familiar and easy. With these tools, patients are not left alone for extended periods of time and the clinician can get a more comprehensive understanding of the patient’s health situation based on real time data.

How remote clinicians support and help their patients achieve their goals in practice is dependent on the individual patient and the chosen treatment. The support can be a reminder to take medications, or tracking the efficacy of current therapies, or supporting lifestyle changes. In other words, healthcare is more present in the daily life of patients, improving adherence and making it more personal.

How Do Digital therapeutics and Remote Clinician Support Work Together in Practice?

Using a digital therapeutic solution for depression, remote licensed therapists can monitor patients in real-time and getting the patient’s daily mood and bi-weekly depression questionnaire results to a dedicated network of therapists is easy. The mobile application prompts the patient to complete a symptom questionnaire. After completing the questionnaire, the data is instantly uploaded onto a clinician dashboard that is used for patient monitoring. The dashboard shows results in a clear and easy to understand manner.
The whole process takes only a couple of minutes, and the therapists always have up to date information on how their patients are doing.

Meru.png 

View of the Meru Health clinician dashboard showing overview of key patient indicators. A therapist can follow patients mood and other statistics in real time, and respond accordingly.

This type constant data collection and ease of communication allows clinicians working with digital therapeutics give frequent and accurate feedback to their patients. This is crucial for keeping patients motivated throughout the treatment, helping them make lasting lifestyle changes. The patient no longer has to wait for days or even weeks for the next visit to his/her clinician for a problem to be recognized and addressed.

Empowering Patients to Change Behavior

Digital therapeutics coupled with clinician support shift more responsibility to the patients so that they can better take control of their own health. In a traditional setting the responsibility is mostly on the provider to prescribe the correct treatment.

On the contrary, digital therapeutic interventions aim to empower patients and encourage them to learn more about their condition. The remote clinician is there mainly to guide the patient, answer questions and provide easy to understand lessons and support for the patient.
As patients become more empowered and can take a more active role in their own treatment, healthcare professionals can effectively help more people in less time. With the explosive increase in chronic diseases, scalable solutions in the marketplace are imperative.

Real Life Digital Therapeutic Solutions and Results

In a study done at the University of California, researchers looked at a digital health coaching intervention program for pre-diabetic patients by Omada Health. The intervention program lasted for 16 weeks and the patients had follow ups done 0.5, 1 and 2 years after the intervention program. The 187 patients lost on average 10 pounds during the 16 week program and successfully kept it off even after two years. Also the participants long term blood sugar levels measured by A1c test improved from 6.02 to 5.56 (9).
 
Touch screen smart blood glucose meter by company called Livongo with access to coaching right on the screen

Meru Health is also showing extremely promising results with our digital therapeutic solution for depression. In a real-world data set of the 141 people who started an 8-week treatment program between March — December 2017, 86% completed it and only 14% dropped out. 75% of people experienced at least a 20% reduction in depressive symptoms and 50% of patients had their symptoms reduced by 50% at three months from the start (10).

In traditional treatment with antidepressants, roughly 46% of depressed patients achieve 50% symptom reduction during avg time of 3 months (11).

Also, around 50% of patients quit antidepressants prematurely (12).

Conclusion

Since digital therapeutics are an emerging category, there are still some related challenges, risks and unknowns. Patient data privacy and security are potential concerns as well as serving patients with multiple chronic diseases. Heavy reliance on smartphones can also be a challenge especially for the elderly and underserved patients. We also need to learn more about how people achieve lasting behavior change.

Despite these challenges, there is a growing amount of published evidence that proves the effectiveness and feasibility of clinician supported digital therapeutics as well as numerous successful implementations around the world. There is no doubt that digital therapeutics are playing a vital role in the future of medicine and healthcare for the benefit and empowerment of everyone.

Co-authored by Valtteri Laine.


About the author: 

Kristian Ranta is the CEO & Founder of Meru Health, an online medical clinic treating depression.

Kristian has been working to innovate healthcare for the past 12 years in the US, Europe and Asia. In 2005, he founded his first company Mendor which developed a novel glucose monitor for people with Type 1 diabetes. That business was later sold to a Korean public company.

In 2005, while Kristian was running his previous company, Kristian lost his older brother Peter to suicide because of his depression. This eventually led to the founding of Meru Health in 2015. Meru Health’s team is on a mission to treat and empower 27 million people suffering from depression by 2027.

Kristian’s passion is to build global businesses that improve healthcare and how it’s been delivered. He believes in humane values, positivity and the importance of reducing suffering in the world.

In his teenage/early 20’s Kristian was a guitarist & singer in a heavy metal band called Norther, which has sold more than100k records and has more than 10 million views on YouTube.

Kristian has studied business, leadership and computer science at several Finnish universities: Aalto University, University of Jyväskylä and Haaga-Helia University of Applied Sciences, wherefrom he holds a Bachelor’s degree.