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More Americans Are Being Treated for Mental Disorders with Medication, not Therapy

A new study has found that the same number of Americans are seeking outpatient treatment for their mental health conditions as the previous decade, yet less are receiving psychotherapeutic treatment.

Even though previous research has shown combined treatment methods that include both psychotherapy and monitored drug therapy to be the most effective in treating a wide array of mental disorders—including mild to severe depressive and anxiety disorders—more Americans are receiving medication only therapies for their psychiatric conditions. National data on outpatient treatment for mental health conditions from 1998 to 2007 reveals that more Americans are receiving medication only therapy while psychotherapy combined with drug therapy and psychotherapy alone have been on a steady decline.

Researchers Dr. Mark Olfson of Columbia University’s Psychiatry Department and Dr. Steven Marcus of University of Pennsylvania’s School of Social Practice and Policy assessed the recent trends in America’s mental health outpatient facilities based on two population-based representative surveys. The researchers analyzed the Medical Expenditure Panel Surveys from 1998 (which contained 22,952 patients’ data) and 2007 (which contained 29,370 patients’ data). Individuals who had made more than one outpatient psychotherapy visit those calendar years were included in the study. Then the researchers compared the rates of any psychotherapeutic use, expenses related to psychotherapy, the average number of visits per psychotherapeutic patient, and the percentages of patients who received psychotherapy only, psychotropic medication only, or combined therapy for their mental health conditions.

According to the study, the percentage of Americans using psychotherapeutic outpatient services remained relatively the same over the ten-year span (3.37% in 1998 and 3.18% in 2007). However, the percentages of patients receiving only psychotherapy (15.9% in 1998 and 10.5% in 2007) and combined psychotherapy and psychotropic medication therapy (40.0% in 1998 and 32.1% in 2007) for their mental health conditions had markedly declined during this period. On the contrary, the percentage of patients receiving only psychotropic medication therapy sharply rose within the ten-year period (44.1% in 1998 and 57.4% in 2007).

Meanwhile, patients also began attending less psychotherapy visits per year, as the average number of visits per patient had lowered from 9.7 in 1998 to 7.9 in 2007. Additionally, researchers found that less federal funding of psychotherapy services had simultaneously occurred during this time, with $10.94 billion being spent in 1998 but only $7.17 billion spent in 2007. Even though the nation saw less expenditures on psychotherapy in 2007, the overall funding of mental health care had remained somewhat the same over the ten years, indicating that the majority of spending may have gone into funding drug therapies.

This general trend in mental health care demonstrates a shift away from the traditional ‘talk therapy’ technique as drug therapies are becoming more commonplace. Although this shift has occurred, the researchers caution that this is not generally the best method of treatment for psychiatric patients. Many patients who could benefit from psychotherapy are not receiving the treatment they need, as combined therapy techniques are the most effective for treating mental health conditions. For example, the study found that among Americans treated for depression, the proportion on medication alone rose from 41% in 1998 to 51% in 2007. Yet the percentage receiving combined therapy fell from 50% to 42% during this time.

However, the researchers also point out that these trends may be a sign of the improvements made to pharmaceutical therapies that are now available today. More people are getting access to treatment medications, making it easier to treat both mild cases as well as severe psychiatric disorders. Yet overall, the researchers are finding the lack of psychotherapy to be unhelpful to Americans. Those with milder symptoms may not require medication and instead might benefit more from cognitive-behavioral therapy. Psychotropic medications may appear to be a simpler, faster method for treating depression or anxiety, but psychotherapy has proven to create successful, lasting effects both with and without medication.

The researchers recommend that patients being prescribed medications for their psychiatric conditions (particularly those being treated by their general health care practitioner and not a mental health specialist) speak to their doctor about other available methods of treatment or ask for a referral.

Olfson and Marcus’s study was published in the August issue of the American Journal of Psychiatry.

Sources: The American Journal of Psychiatry, Mark Olfson, MD., MPH, and Steven C. Marcus, PhD, National Trends in Outpatient Psychotherapy, August 4, 2010

Reuters Health, Amy Norton, More mental disorders treated with drugs only, August 19, 2010

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