Digital therapeutics in depression and bipolar disorder: a comprehensive systematic review

INTRODUCTION: Digital therapeutics (DTx) represent a novel approach to treat mood disorders like major depressive disorder (MDD) and bipolar disorder (BD). Treatment can usually be based on interventions such as cognitive behavioral therapy (CBT) and psychoeducation, and they can be relatively inexpensive and more easily accessible. However, upscaling DTx in clinical practice is relatively slow due to regulatory barriers, lack of sufficient clinical evidence, and patient nonadherence. EVIDENCE ACQUISITION: A systematic review following the PRISMA guidelines was carried out through MEDLINE/ PubMed and Scopus. All studies exploring the use of DTx for MDD and BD were assessed. While excluding studies not presenting any clinical results or not aimed at DTx but instead at general digital mental health (DMH) interventions. EVIDENCE SYNTHESIS: Initial search strategy produced 4598 papers, 24 of which have been selected and discussed. Most studies were conducted on MDD, rather than BD. Most frequently used approaches included CBT, psychoeducation and mindfulness. Most studies reported positive changes in mood symptoms, but only some of them provided information about the maintenance of these results in the long term. Among inhibitors in the acceptability of DTx were represented by limited real-world evidence, engagement issues and inconsistent regulatory environments. CONCLUSIONS: Using DTx for mood disorders shows great promise. Effective interventions that are accessible and modeled are feasible. However, to structurally incorporate DTx into standard clinical practice, there is the need to develop clear regulatory channels, improve user’s involvement and provide additional evidence of long-term efficacy.