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Aim: Live two‐way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real‐world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large‐scale pragmatic, randomized controlled trial to determine the effectiveness of long‐term treatment for multiple psychiatric disorders via two‐way video using smartphones and other devices, which are currently the primary means of telecommunication. Methods: This randomized controlled trial compared two‐way video versus face‐to‐face treatment for depressive disorder, anxiety disorder, and obsessive‐compulsive disorder in the subacute/maintenance phase during a 24‐week period. Adult patients with the above‐mentioned disorders were allocated to either a two‐way video group (≥50% video sessions) or a face‐to‐face group (100% in‐person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36‐Item Short‐Form Health Survey Mental Component Summary (SF‐36 MCS) score. Secondary outcomes included all‐cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. Results: A total of 199 patients participated in this study. After 24 weeks of treatment, two‐way video treatment was found to be noninferior to face‐to‐face treatment regarding SF‐36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all‐cause discontinuation, treatment efficacy, and satisfaction. Conclusion: Two‐way video treatment using smartphones and other devices, was noninferior to face‐to‐face treatment in real‐world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care. [ABSTRACT FROM AUTHOR]