Depression Treatment Up, With More Using Drug Therapy

The number of people receiving treatment for depression has increased "dramatically" since 1987, according a new study, the Washington Post reports. Published in today's issue of the Journal of the American Medical Association and led by a Columbia University researcher, the study found that between 1987 and 1997, the percentage of Americans being treated for depression "tripled nationwide" from 0.7% to 2.3% (Vedantam, Washington Post, 1/9). During the same time period, antidepressant use jumped from 37% of patients to about 75%, while the number of patients receiving psychotherapy dropped from 71% to 60% (Tanner, AP/USA Today, 1/9). The study also found that the number of visits to physicians for depression decreased from about 12 per patient to eight. "Large numbers" of patients received depression treatment from primary care physicians and others "outside" the mental health field (Washington Post, 1/9). Researchers based the findings on data from two surveys, one conducted in 1987 by HHS and a second conducted in 1997 by the Agency for Healthcare Research and Quality. Data from the 34,459 participants in the first study was compared to data from the 32,636 participants in the second one (AP/USA Today, 1/9).

Experts said the increased number of people receiving treatment "probably" does not indicate an increase in depression but is more likely linked to the "destigmatization of mental health" (Washington Post, 1/9). During the 1980s, public health campaigns pushed to improve mental health screenings, and drug companies began "heavily promoting" new antidepressants such as Prozac. Now, the study reported, the "pharmacologic treatment of depression is becoming less stigmatized," with Americans "much more willing" to undergo drug therapy. In addition, "business factors" such as direct-to-consumer drug advertising and managed care limits on psychotherapeutic counseling have helped change the way depression is treated (Hall, San Francisco Chronicle, 1/9). The Post reports that antidepressants, particularly Prozac, which have fewer side effects than older medications, were "embraced" quickly by managed care companies as a way to shift away from "lengthy periods of psychoanalysis." As a result, such drugs began to be prescribed for "a vast array of conditions and disorders" (Washington Post, 1/9) But Harold Pincus, vice chair for psychiatry at the University of Pittsburgh and one of the study's authors, said the findings do not mean that the quality of care for depression has improved. "On average, the intensity of care being provided is somewhat less than it was, and we really don't know about the quality of care"(San Francisco Chronicle, 1/9). "[T]here are reasons to suggest there are problems with quality," he added. For example, many patients do not refill antidepressant prescriptions, even though one prescription is not likely to improve the problem. At the same time, primary care physicians are "overburdened" and have little reason to provide follow-up treatment, the Post reports (Washington Post, 1/9). Advocates for the mentally ill also say medications are not available for the uninsured (San Francisco Chronicle, 1/9).

Although managed care has favored pharmaceutical treatments, psychologists say that drugs are more expensive and less effective than therapy because they do not "address the underlying causes of depression" or prevent relapse. Geoffrey Reed, assistant executive director for professional development at the American Psychological Association, said, "It is much more likely and much easier for the physician to say, 'Okay, you're feeling depressed, here, try this pill,' instead of exploring the option of psychotherapy and make a recommendation to a mental health provider." He noted that the trend toward drug treatment runs contrary to patients' preferences for psychotherapy. Pincus added, "The biggest problem is the failure to take a longitudinal perspective on the illness. These are chronic illnesses -- it's not a one-shot deal" (Washington Post, 1/9). The study is available at http://jama.ama-assn.org/issues/v287n2/rfull/joc11356.html.