Prescribing Mental Health Apps

Bret Stetka, MD

Disclosures

June 05, 2019

While at the poster session at this year's American Psychiatric Association (APA) annual meeting, Medscape interviewed Hephsibah M. Loeb, MD, a resident at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and coauthor of a recent study on the use of smartphone apps for mental health.[1] Now that the US Food and Drug Administration (FDA) has approved the use of prescription apps, it has become increasingly important for psychiatrists to consider their potential risks and benefits, Loeb said.

A Prescription You Can Download on Your Phone

Mental health apps are increasingly being used by patients and the general public. What was the motivation behind the study you presented here at APA?

The intention was to see how psychiatrists can collaborate with patients in how they use mental health tools outside of the office, as well as ways to make treatment and self-help more accessible, because a lot of patients are using apps and the Internet to guide their healthcare choices.

I became interested in the topic when I read about the first FDA-approved app in 2017, called reSET, which is used to treat substance use disorders. Then I became more broadly interested in apps, but I wanted to stick to the literature to understand the evidence surrounding this. I learned about the PRIME-D study,[2] which investigated the efficacy of online-only treatment for a cohort of patients with depression. And I wanted to focus on clinically relevant takeaways, so I incorporated the APA App Evaluation Model. That's how the project evolved.

Roughly how many apps are approved currently by the FDA?

For mental health, there are just two that I know of, reSET and reSET-O, a version of the app for patients with opioid use disorder, which I believe is intended to be used in conjunction with buprenorphine administration. However, there are also variants for indications like diabetes, where you track blood glucose.

These apps are developed for clinicians to prescribe?

Yes. reSET is by prescription only, so I couldn't even look at the actual apps. You have to be prescribed the app to even open it. Then the data that the patient puts into the apps is accessible by the clinician. That would differentiate it from something like Calm, the meditation app that a lot of people use, or other apps that people use that could have some psychoeducational components.

I was thinking more specifically about doctors using apps with patients. The recommendations state that we as doctors should ask patients what apps they're using, because that could enhance treatment and also prevent patients from potentially getting misinformation.

What the Evidence Shows

What available efficacy data do we have in support of these mental health apps?

I came across two studies that show efficacy in certain areas. One study shows that patients who are not abstinent from substance use at baseline are more than twice as likely to be abstinent after 12 weeks as patients who were not using the app.[3]

Then there is another study of a program for patients to get treatment from their depression solely online.[2] They interacted with what the paper describes as "motivation coaches" and with each other; there's a social component to it as well, which patients reported that they found helpful.

Do you think that this is going to become an integral part of mental health care?

I think there are a lot of potential benefits to apps. We can see that patients could have increased access to care. It wouldn't be affected by certain aspects, such as transportation. There's less stigma to accessing care. It can also enhance care if patients are in treatment.

However, the significant downside is the privacy aspect. That's why it's really important for clinicians to proactively try to engage patients in order to advise them about issues such as privacy, which is protected by HIPAA in the office or hospital. For example, one of my colleagues asked me, "Well, what if an airline pilot is logging his suicidal thoughts? Who has access to that?"

There are a lot of great parts to it, but then there's also the potential for misinformation. People could diagnose themselves with a condition that they might not have. That's why I think it's important to work with a clinician, and clinicians should also be educated about these factors so that patients stay safe.

So, much like any drug, there are going to be concerns and potential side effects around anything you prescribe.

Exactly.

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