Les traitements psychologiques sur Internet se sont beaucoup développés durant cette dernière décennie. Parmi les traitements proposés, les thérapies cognitivo-comportementales tiennent une place majeure et notamment dans la prise en charge de syndromes dépressifs. Ces interventions se sont montrées efficaces au moins à court terme. L’objectif de cet article est une brève présentation de sept programmes ayant montré une efficacité dans le traitement de la dépression : MoodGym, E-couch, MomMoodBooster, Mom-Net, Depressionshjälpen, Sadness Program et Deprexis. La découverte des différentes possibilités techniques proposées par ces sept programmes permettent d’isoler des paramètres de qualités pour la mise en place ou l’optimisation de ce type de sites dans le futur. Ces critères sont : 1) l’accessibilité, 2) l’adaptation à la langue maternelle du patient et à sa culture, 3) l’adaptation à la pathologie du patient et de ses comorbidités, 4) l’anonymisation, 5) la qualité du contenu thérapeutique (thérapies cognitivo-comportementales, psychoéducation, relaxation…), 6) l’ergonomie des documents numériques, 7) la présence d’un forum de discussion, 8) la possibilité d’être dirigé vers une aide urgente, 9) le suivi personnalisé par un thérapeute, 10) l’engagement du patient vers un suivi et enfin 11) le lien avec le médecin généraliste et/ou le psychothérapeute du patient.

Depression is a major public health problem. In 2010, the number of people suffering from major depression was estimated at around 298 million (Ferrari et al., 2013) [1Ferrari A.J., Charlson F.J., Norman R.E., Flaxman A.D., Patten S.B., Vos T., e al. The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study 2010 PLoS ONE 2013 ;  8 (7) : e69637

Cliccare qui per andare alla sezione Riferimenti]. Depression is the fourth most debilitating illness in the world and risks becoming the leading cause of disability in the developed world by 2030 (Mathers et Loncar, 2006) [2Mathers C.D., Loncar D. Projections of global mortality and burden of disease from 2002 to 2030 PLoS Med 2006 ;  3 (11) : e442

Cliccare qui per andare alla sezione Riferimenti]. Lifetime prevalence of this disorder is 16.2% and annual prevalence is 6.6% (Kessler et al., 2003) [3Kessler R.C., Berglund P., Demler O., Jin R., Koretz D., Merikangas K.R., e al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R) JAMA 2003 ;  289 (23) : 3095-3105 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti]. The potential benefits of early intervention are clear and it is necessary to facilitate access to treatment for sufferers (Cuijpers et al., 2008; Garber et l., 2009) [4Cuijpers P., van Straten A., Smit F., Mihalopoulos C., Beekman A. Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions Am J Psychiatry 2008 ;  165 (10) : 1272-1280 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 5Garber J., Clarke G.N., Robin Weersing V., Beardslee W.R., Brent D.A., Gladstone T.R.G., e al. Prevention of depression in at-risk adolescents JAMA 2009 ;  301 (21) : 2215-2224 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti]. Among the range of psychological therapies, cognitive behavioral therapy (CBT) is known for its efficiency in dealing with depression, either alone or alongside medication (Parikh et al., 2009) [8Parikh S.V., Segal Z.V., Grigoriadis S., Ravindran A.V., Kennedy S.H., Lam R.W., e al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication J Affect Disord 2009 ;  117 (Suppl. 1) : S15-S25

Cliccare qui per andare alla sezione Riferimenti]. Unfortunately, as with many mental disorders, sufferers have difficulty initiating treatment. The Internet could therefore be a useful tool in the prevention and treatment of certain mental disorders such as depression. Over the last few years, CBT on the web, known as iCBT (Internet Cognitive Behavioral Therapy), has become more widely available. Literature reviews and meta-analyses have already been published on this subject (Andersson et Cuijpers, 2009; Griffiths et al., 2010; Richards et Richardson, 2012; So et al., 2013) [9Andersson G., Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis Cogn Behav Ther 2009 ;  38 (4) : 196-205 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 10Griffiths K.M., Farrer L., Christensen H. The efficacy of Internet interventions for depression and anxiety disorders: a review of randomised controlled trials Med J Aust 2010 ;  192 (Suppl. 11) : S4-S11

Cliccare qui per andare alla sezione Riferimenti, 11Richards D., Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis Clin Psychol Rev 2012 ;  32 (4) : 329-342 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 12So M., Yamaguchi S., Hashimoto S., Sado M., Furukawa T.A., McCrone P. Is computerised CBT really helpful for adult depression? - A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity BMC Psychiatry 2013 ;  13 : 113 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti]. The efficiency of iCBT treatment for depression has been proven but with a variation in efficiency between different meta-analyses. The effect sizes in favor of iCBT are small to medium. The long-term efficiency has been widely debated given the large number of patients who disappear (So et al., 2013) [13DEPRESSIONSHJÄLPEN: Inloggningssida.. landing-depression.aspx

Cliccare qui per andare alla sezione Riferimenti]. The aim of this article was to identify and describe different iCBT programs mentioned in scientific literature, which treat depression. As the websites were not always accessible, this review was compiled either from descriptions contained in scientific articles or by associating data from the literature and visiting sites online wherever possible. We found seven programs with proven efficiency in the treatment of depression: MoodGym, E-couch, MomMoodBooster (Danaher et al., 2012) [33Danaher B.G., Milgrom J., Seeley J.R., Stuart S., Schembri C., Tyler M.S., e al. Web-based intervention for postpartum depression: formative research and design of the MomMoodBooster Program JMIR Res Prot 2012 ;  1 (2) : e18

Cliccare qui per andare alla sezione Riferimenti], Mom-Net (Sheeber et al., 2012) [36Sheeber L.B., Seeley J.R., Feil E.G., Davis B., Sorensen E., Kosty D.B., e al. Development and pilot evaluation of an Internet-facilitated cognitive-behavioral intervention for maternal depression J Consult Clin Psychol 2012 ;  80 (5) : 739-749 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti], Depressionshjälpen (Carlbring et al., 2013) [14Carlbring P., Hägglund M., Luthström A., Dahlin M., Kadowaki Å., Vernmark K., e al. Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial J Affect Disord 2013 ;  148 (2–3) : 331-337 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti], Sadness Program and Deprexis. Despite the fact that all these programs offer cognitive behavioral therapy for depression, they are all very different. However, according to the authors, due to the diversity in form and content, it was possible to isolate quality criteria that could be used in setting up future iCBT programs or in improving existing ones. The criteria were based on ethical, democratic and treatment effectiveness aspects as well as the technical capacity currently offered by the Internet. The programs should: 1) be freely accessible, free of charge and compatible with different operating systems (Windows, IOS, Unbutu), tablets and smart phones, 2) be available in the mother tongue of the patient and culturally adapted, 3) be adapted to the pathology of the patient and their co-morbidities, which implies a reliable diagnosis with the help of hetero-questionnaires, 4) respect patient anonymity, 5) offer efficient therapeutical techniques (cognitive behavioral therapy, psychoeducation, relaxation…) adapted to the pathology, its intensity, its evolution and its co-morbidities, 6) provide easy-to-use high-quality documents with playful and attractive interfaces (drawings, photos, dialogues, flash animation) and be flexible, 7) contain a discussion forum, 8) provide the possibility of direction towards emergency help if needed, 9) provide personalized care by a therapist (by email, by telephone or face to face) if necessary, 10) direct the patient towards a follow-up to prevent a relapse and/or recurrence (psychoeducation, appointments with a local therapist or physician) and finally 11) with the agreement of the patient, involve their physician and/or their psychotherapist to ensure coherent treatment and follow-up. None of the programs mentioned above completely fulfilled these criteria. However, the sites Moodgym, Sadness Program and MomMoodBooster provided the closest match.