There have been numerous studies examining the effectiveness of long-distance psychotherapy as an alternative means of accessing and improving clinical outcomes for patients with depressive or anxiety disorders (Choi et al. Depress Anxiety 2014; epublished February 5, 2014; Lam et al. Br J Psychiatry 2013;203:358-365).

In recent years, the Internet has been used to deliver cognitive-behavioural therapy (CBT), psychodynamic psychotherapy and guided self-help programs (Johansson et al. BMC Psychiatry 2013;13:268, free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3852703/pdf/1471-244X-13-268.pdf). Reins et al. BMC Psychiatry 2013;13:318, free full text at www.biomedcentral.com/content/pdf/1471-244X-13-318.pdf).

The latest alternative to face time is Facebook. A new study has examined whether joining Facebook – and specifically “friending” the psychiatrist – is beneficial in patients with treatment-resistant depression (Mota Pereira J. Scientific World J 2014;2014:892048; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3916106/pdf/TSWJ2014-892048.pdf). 

The study enrolled 60 Facebook-naïve patients with treatment-resistant depression, defined as failure to achieve symptomatic remission after two adequate antidepressant trials. The patients’ current treatments included SSRIs, tricyclic antidepressants, venlafaxine or agomelatine, with the addition of lorazepam as needed. Subjects continued their individual drug therapy and were randomized to Facebook alone (F), Facebook with psychiatrist as “friend” (FF), or a control group (C) with no Facebook but regular consultations with their psychiatrist. The two Facebook groups spent at least 1 hour per day, 7 days a week on Facebook for the duration of the three-month study. Mean baseline depression scores were similar in the three groups on the 17-item Hamilton Depression Rating Scale (16.35 to 19.10) and Beck Depression Inventory (17.35 to 20.50).

At month 2, both Facebook groups showed improvements in HAM-D-17 and BDI scores; differences were significant versus placebo and against their own baseline scores. Improvement was more rapid in the FF group, with significant improvement at month 1. At the end of three months, the proportion of patients achieving a response (FF 17.6%; F 20.0%) or remission (FF 35.3%; F 20.0%) was significantly greater compared to controls (0% for response or remission).

Facebook has achieved some notoriety in some circles, raising the question of whether social networking promotes social interaction or denotes social withdrawal. Much of the controversy centres around the concept of “Facebook depression”. The term originates from a study suggesting that co-rumination (excessively discussing problems with friends) is associated with depressive symptoms in early-adolescent girls (Starr & Davila. J Adolesc 2009;32:19-37; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC2652577/pdf/nihms93087.pdf). In reporting on the study, the media coined the term “Facebook depression” (www.telegraph.co.uk/technology/facebook/4405741/Excessive-chatting-on-Facebook-can-lead-to-depression-in-teenage-girls.html), although social networking was not examined in the study. The American Academy of Pediatrics’ Council on Communications and Media subsequently adopted the term as a clinical entity, defining it as “depression that develops when pre-teens and teens spend a great deal of time on social media sites, such as Facebook, and then begin to exhibit classic symptoms of depression” (O’Keeffe et al. Pediatrics 2011;127:800-804).

While this implies that Facebook use is a causative factor in depression, this was not established in the two studies referenced by the Council. Indeed, one of the cited studies found the opposite:  Internet use for communicating with peers was predictive of less depression among adolescents (Selfhout et al. J Adolesc 2009;32:819-833). Adolescents who spent more time surfing and not interacting with peers appeared to be at greater risk of depression and social anxiety.

Specific studies examining the relationship between social networking and depression have produced mixed results. One study that specifically investigated “Facebook depression” found no correlation between social networking use and clinical depression (Jelenchick et al. J Adolesc Health 2013;52:128-130). Conversely, a study of high school students found that the time spent on social networking sites was correlated with BDI scores (Pantic et al. Psychiatr Danub 2012;24:90-93). However, it is conceivable that Facebook use was a means of coping with depressive symptoms and/or was information-seeking behaviour rather than a cause of depression.

Facebook status updates have been used to identify individuals experiencing a major depressive episode, however, the authors noted that such disclosures may be helpful in eliciting social support from friends (Facebook or otherwise) and could be beneficial in destigmatizing mental illness among adolescents (Moreno et al. Depress Anxiety 2011;28:447-455).