The Second Part: Application of Digital Technology to Major Depressive Disorder

Development of VR Digital Therapy and Challenges in Dissemination

Development of VR Digital Therapy for Depression
As one of the treatment options for major depressive disorder (MDD), there is a movement toward research and development. In this issue, I introduce digital therapies using VR (Virtual Reality), some of which have been approved by the US Food and Drug Administration (FDA) in the last five years in rehabilitation and chronic pain and are gradually gaining more attention. 

Therapy of MDD was mentioned in the previous article. Still, there are many different types of MDD, and it has been reported that approximately one in three treated people do not respond to medication. ^１) One of the symptoms behind this treatment responsiveness is ruminative thinking. The repetition of self-denial and over-generalizing thoughts from some experiences can contribute to the onset or exacerbation of MDD. However, there is a lack of treatment methods that focus on improving this ruminative thinking.

In the face of these challenges, there have been reports that VR digital therapy for MDD has effectively reduced symptoms as a complement to medication. ²⁾ Being cut off from the outside world allows the user to concentrate on the space within the VR content, and experiences that are not possible in reality, such as listening to oneself from another person’s perspective. As the training takes place in a virtual environment, it will also reduce the risk of privacy.

In Japan, a company actively developing VR digital therapy for MDD is BiPSEE, Inc. ³⁾ It is based on therapeutic techniques such as cognitive-behavioral therapy. It is currently conducting clinical research with a research institute at Kochi University. Preliminary research suggests that experiencing a VR program, which aims to acquire coping skills for ruminative thinking, improves depressive symptoms and excessive ruminating thoughts. Future research will also explore the factors that made the introduced program effective in improving symptoms and to research them following strict development protocols to develop it as a medical device.

Perspectives from Active Psychiatrists and Challenges in Dissemination
In treating acute and exacerbation/relapse phases of MDD, medication is still considered the priority for the time being if the severity of the illness requires hospitalization. However, I felt that digital healthcare could significantly contribute to developing areas that monitor the course of the condition, treatment in outpatient clinics, support the recovery phase, and prevent symptom flare-ups.

As in other disease areas, self-monitoring makes it easier to follow the course of symptoms in a more sustained and acute manner. Sharing data on progress with patients and their families will help to eliminate gaps in healthcare providers’ perceptions. The data will also allow for more concrete discussions on assessing factors contributing to symptom changes and how to deal with them. If the data can be visualized in graphs and other forms, it will be more effective and easier to understand.

Digital healthcare is also expected to be effective in MDD with cognitive-behavioral therapy. In cases where medication alone does not seem to be effective, there is potential for treatment to progress with the combined use of programmed medical devices.

However, while some patients are diagnosed with MDD only, there are many cases in clinical practice where other psychiatric disorders coexist. After the effectiveness of the treatment for depression alone is sufficiently confirmed, it may be one of the things we would like to verify in future clinical studies to see if the treatment is also effective for patients with comorbid conditions.

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