Scientists from Sweden tested whether a smartphone game can enhance the effect of antidepressants. The results of a randomized controlled trial - a study in which participants are randomly assigned to groups - were published in the Journal of Affective Disorders.
Depression affects about 300 million people worldwide. Many patients take antidepressants, but symptoms persist. Another problem is nonadherence to medication regimens.
Researchers from Linkoping University led by Josefine Bremer studied the FIGARO program. It included the game Fig: The Game for Depression, optional online cognitive behavioral therapy (CBT - a psychotherapy method that changes thoughts and behavior) modules, and the option to contact a therapist on request. The game encourages adherence to medication, sleep, nutrition and physical activity by allowing users to build virtual worlds.
The trial involved 148 adults from Sweden who were taking antidepressants and had residual depression symptoms. Mean age was 40 years, 82% women. A current major depressive episode was diagnosed in 66%, and recurrent depression (repeated episodes) in 72%.
Participants were randomly divided into two groups. Both were offered a nine-week program, but the treatment group received access immediately, while the waiting group received it two weeks after the end of the intervention period.
Before and after the program, depression, anxiety, treatment adherence (how closely a patient follows the doctor's prescriptions) and quality of life were assessed. There were also brief weekly surveys about symptoms.
It turned out that 79% of participants in the treatment group installed the game, and they completed an average of 81 game sessions. About 32% contacted a therapist, and 28% completed at least one therapeutic task. Compared with the waiting group, the treatment group showed a moderately greater reduction in depression and anxiety symptoms. An improvement of at least 30% on the depression scale was reported by 51% in the treatment group versus 19% in the waiting group, although an improvement of 50% or more was seen in only 16%.
Treatment adherence also improved, with an effect ranging from small to moderate. Quality of life did not differ between the groups. The results for depression and anxiety held under different methods of accounting for dropouts, but the adherence effect weakened and, under the most conservative assumption, ceased to be statistically significant.
The intensity of use of the game or online platform was not associated with improvement. Among those who responded to the satisfaction survey, 69% were rather or very satisfied with the treatment.
The authors conclude that access to a multicomponent digital program (the EU-certified game Fig, optional CBT modules and therapist support on request) may provide short-term improvements compared with a waiting list in adults taking antidepressants with residual symptoms. These are preliminary data.
Limitations: 41% in the treatment group did not complete the post-treatment assessment versus 18% in the control group; participants knew their group; all outcomes were self-reported; 21% never installed the game. Comparison with a waiting list does not rule out an expectancy effect, and the results cannot be attributed only to the game rather than to the entire program. Only short-term effects were assessed, and participants recruited through advertising may be more motivated than typical patients. The study was funded by the developer of Fig - Mindforce Game Lab; according to the authors, it did not participate in data collection, data analysis, interpretation or writing of the article.