Antidepressant Use Rising as Psychotherapy Rates Fall
MONDAY Dec. 6, 2010 -- Even as fewer Americans have sought psychotherapy for their depression, antidepressant prescription rates have continued to climb in recent years, a new survey reveals.
"This is an encouraging trend as it suggests that fewer depressed Americans are going without treatment," said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University/New York State Psychiatric Institute in New York City. "At the same time, however, the decline in psychotherapy raises the possibility that many depressed patients are not receiving optimal care."
"While progress is being made in increasing the availability of depression care, a mismatch is opening up between clinical evidence and practice," Olfson cautioned. "For many depressed adults and youth, a combination of psychotherapy and antidepressants is the most effective approach. Yet, only about one-third of treated patients receive both treatments, and the proportion receiving both treatments is declining over time. Efforts should be made to increase the availability of psychotherapy for depression."
Olfson and his colleagues report the findings in the December issue of the Archives of General Psychiatry.
The authors noted that previous research indicated that depression treatment rose significantly between 1987 and 1997, from less than 1 percent to nearly 2.5 percent. Antidepressant use among depressed patients rose similarly, from just over 37 percent to more than 74 percent. At the same time, however, the percentage of patients undergoing psychotherapy dropped, from about 71 percent to 60 percent.
Newer medication options (including the introduction of serotonin selective reuptake inhibitors, or SSRIs), streamlined treatment guidelines, and improved screening tools accounted for the bump in overall treatment.
For the study, the researchers analyzed data from two national surveys on depression, one conducted in 1998 and one done in 2007. In that time period, there was a small increase in outpatient treatment rates (from 2.37 per 100 people to 2.88 per 100 people), and only a nominal bump in antidepressant use.
However, the percentage of patients seeking psychotherapy for depression plummeted, from nearly 54 percent to just above 43 percent.
The study authors theorized that a number of factors are driving the trend, not all of which reflect patient preferences. For example, they pointed out that the rise in the rate of prescription drug use may have slowed somewhat as a result of safety concerns, particularly with respect to their usage among younger patients.
At the same time, Olfson and his team noted that today's health insurance coverage often provides payment for cheaper medicinal treatments, while placing strict limits on more expensive psychotherapy treatment.
"I don't see these trends as alarming," said Dr. Michael W. O'Hara, a professor of psychology at the University of Iowa, in Iowa City. "Especially given that it seems to me that there's a lot more visibility to depression and an increasing acceptance to it being treated in general. It's just that the proportion of people being treated with prescription drugs has been going up relative to psychotherapy."
"Now my experience is that many patients say they prefer to just talk to somebody," O'Hara noted. "But certainly it's true that there are many barriers to that, such as the fact that getting psychotherapy requires some effort, you have to go someplace, it may cost you more out-of-pocket, and there may be more stigma involved than just taking drugs."
"It's also the case that one of the things we're seeing as well is that antidepressant medication is now very heavily marketed directly to the consumer," he added. "I would argue that there has been a dramatic increase in TV, radio, print ads advocating that patients take these medications. Now think about the last time you saw an ad for cognitive behavioral therapy for depression. You probably never have. So where are the shoppers going to go? They'll go to the place that is advertising. I'm not saying that's good or bad or anything. But it's certainly a factor."
In a second study published in the same journal, a Canadian team from Centre for Addiction and Mental Health in Toronto found that mindfulness-based cognitive therapy appears to be as effective as antidepressants at helping successfully treated depression patients stay well.
The findings stem from work with 160 depression patients between the ages of 18 and 65, some of whom were offered counseling in place of antidepressants to help them learn to track and influence their own thinking patterns during moments of sadness.
For more on the treatment of depression, visit the U.S. National Institute of Mental Health.
Posted: December 2010
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