Fewer People Turn to Psychotherapy for Depression

More Americans are getting treatment for depression—but much of that treatment appears to be in drug form instead of psychotherapy.

A new study looked at data from two national surveys on depression, one conducted in 1998 and one done in 2007. In that time period, outpatient treatment rates rose slightly—from 2.37 per 100 people to 2.88 per 100 people—and antidepressant use bumped up nominally.

The significant change came in the number of people seeking psychotherapy for depression. That figure plummeted, from nearly 54 percent to just above 43 percent.

Concern about care

The downward trend in psychotherapy is troubling for the researchers. “The decline in psychotherapy raises the possibility that many depressed patients are not receiving optimal care," says Mark Olfson, M.D., at Columbia University/New York State Psychiatric Institute in New York City.

Dr. Olfson and the other researchers note that previous research indicated that depression treatment rose from less than 1 percent in 1987 to nearly 2.5 percent in 1997. 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 serotonin selective reuptake inhibitors (SSRIs), streamlined treatment guidelines, and improved screening tools, accounted for the bump in overall treatment.

“For many depressed adults and youth, a combination of psychotherapy and antidepressants is the most effective approach,” says Dr. Olfson. “Yet, only about one-third of treated patients receive both treatments, and the proportion receiving both treatments is declining over time.”

Reasons for the trend

The researchers suggest that several factors are driving the trend, not all of which reflect patient preferences. For example, the use of antidepressant drugs may have slowed because safety concerns, particularly in children and teens.

At the same time, today's health insurance coverage often provides payment for cheaper medicinal treatments, while placing strict limits on psychotherapy, which is more expensive.

Another reason for the trend toward medication for depression may be high-profile ads by drug companies. “Antidepressant medication is now very heavily marketed directly to the consumer," says Michael W. O’Hara, Ph.D., at the University of Iowa. “"I would argue that there has been a dramatic increase in TV, radio, print ads advocating that patients take these medications.”

Always talk with your health care provider to find out more information.