August 20, 2010

Growing Number Of Psychiatric Patients Treated Solely With Drugs

More mental health patients are being treated solely with drugs today than a decade ago, suggesting a redefinition of mental health care within the U.S., according to a new study published in this month's American Journal of Psychiatry.

The study, based on data from two government health surveys conducted in 1998 and 2007, also found that the use of "talk therapy" had declined during that time.
The researchers found that the percentage of Americans who reported having at least one psychotherapy session over the past year remained constant at just over 3 percent in both 1998 and 2007.  However, among those receiving outpatient mental health care, the proportion being treated with drugs alone increased from 44 percent in 1998 to 57 percent in 2007.

Combined treatment with psychotherapy and drugs declined from 40 percent to 32 percent, while the use of psychotherapy alone dropped from 16 percent in 1998 to about 10 percent in 2007, the researchers found.

Total U.S. spending on psychotherapy also dropped from an estimated $11 billion in 1998 to $7 billion in 2007, even though overall spending on mental health care remained fairly constant at approximately $16 billion.

The implications of these changes are unclear, they said, but the findings suggest an increase in the proportion of mental health spending on drug therapies.

"This represents a fairly dramatic shift in mental health treatment, and it is not necessarily good news for many patients," said Dr. Daniel Carlat, an associate clinical professor of psychiatry at Tufts University School of Medicine, during an interview with Reuters.

"What concerns me most is that there was a 20 percent drop in treatment combining therapy with medication," said Dr. Carlat, who was not involved in the current study.

This "integrative" treatment protocol is frequently the most effective, he said.

Clinical psychiatry professor Dr. Mark Olfson of Columbia University in New York agreed.

"I think there are some reasons for concern," said Dr. Olfson, one of the study's authors.

For instance, with depression there is evidence that combination therapy is better than drugs alone, he told Reuters.

Indeed, the largest study to date of adolescent depression found that combined therapy was typically more effective than either drugs or talk therapy alone, Dr. Olfson said.

That study, known as TADS (Treatment for Adolescents with Depression Study), found that combination therapy was more effective in lessening suicidal thoughts in teens.

The current study revealed that among those treated for depression, the proportion treated with medication alone rose from 41 percent in 1998 to 51 percent in 2007.   Meanwhile, the proportion receiving combination treatment dropped from 50 to 42 percent.

On the "positive" side, the movement towards the more prevalent use of medication alone means that some who might not have received any care at all in the past are now receiving treatment, Dr. Olfson said.

"Mental health care is evolving in a way that means more people are receiving treatment, but are not necessarily getting the most effective therapy."

The study was not designed to identify the underlying cause of the trend, but Dr. Olfson said one possible factor might be the increased marketing of psychiatric drugs to both doctors and the general public.

Other factors might include a general increase in understanding that mental health disorders have biological foundations and, for some, a perception that drugs alone may be the better treatment approach since it requires less time and offers potentially quicker results.

Furthermore, whereas primary care physicians can prescribe psychiatric medications, psychotherapy requires a referral to a psychiatrist, psychologist, social worker or mental health specialist.

Primary care physicians now issue the vast majority of psychiatric drug prescriptions in the U.S., wrote Dr. Olfson and Dr. Steven C. Marcus in a report about the study.

Although the implications of the study for Americans' mental health care are unclear, Dr. Olfson advised those who are being newly prescribed a psychiatric medication to ask their physicians about any alternative treatments that may be available.

This is particularly important for those exhibiting milder symptoms. 

Generally speaking, psychiatric medications are most effective for those with more severe disorders, Dr. Olfson said.

A Reuters report cited the National Institute of Mental Health as saying that 10 percent of U.S. adults experience depression in any given year, with 18 percent suffering from some form of an anxiety disorder.
"¨One of the most common and well-studied forms of psychotherapy is cognitive-behavioral therapy, which includes examining how a patient's thoughts affect their emotions.  Patients are then taught effective ways to alter behavior patterns that might be negatively affecting their mental well being.

The study was published online August 4, 2010, in the American Journal of Psychiatry.  An abstract can be viewed at http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2010.10040570v1?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Olfson&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT.


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