Technology-based advances in the management of depression - Focus on the COPE (TM) program

Depression remains under-recognised and under-treated despite it being more disabling than any other medical disorder and the availability of effectiv e protocol-based psychotherapy and pharmacotherapy treatments. Prevailing p sycho therapy seldom employs evidence-based treatments, continuing instead the use of idiosyncratic psychotherapies of dubious value. Computer interview programs have been developed and evaluated that have the potential to make protocol-based psychotherapy of proven efficacy availabl e over the Internet. Interactive voice response (IVR) makes these programs even more accessible through any touch-tone telephone. COPE(TM) is a self-help program for patients with depression that combines a series of booklets, videotapes and IVR telephone calls. One trial reporte d significant reductions in Hamilton Depression Rating Scale scores in pati ents with depression who completed a 12-week COPE(TM) program. Impediments to dissemination of these computer tools that complement, suppl ement and reinforce best practice values include developer's limited knowle dge of business practices and the slow change of practice paradigms.