A new study we reported on yesterday shows that over a nearly ten year period from 1996 to 2005, antidepressant use went up 75 percent (if going by the researcher’s percentages, not “doubled” as many mainstream news organizations are reporting), while psychotherapy use decreased.

How much did psychotherapy use decrease? Over 35% in the same time period, amongst those who were being treated with an antidepressant.

While that’s an astonishing statistic in itself, it comes with a few disclaimers. Antidepressants are, by far, the most prescribed psychiatric medication in society today. And the vast majority of those prescriptions (more than 80 percent) are made by general practitioners — not psychiatrists. That’s important to note, because while a psychiatrist might well understand the complexities and difficulties in treatment depression, many family physicians and general practitioners do not. They might make a recommendation for psychotherapy in passing, but have little time to ensure the patient follows-up on the recommendation. A psychiatrist, on the other hand, better understands the value of psychotherapy and might make it a requirement of being prescribed an antidepressant through them.

If you were not taking an antidepressant drug for your depression — for example, you were only in psychotherapy or weren’t being treated at all for it — that data was not included in this study. It only looked at people taking an antidepressant drug, likely skewing the results about other treatments.

Of course, none of this is happening in some sort of mental health vacuum.

With greater diagnoses of every diagnostic condition group examined, it’s no wonder more pill treatments are being prescribed. People like pills, because they are easy to take and require little change on the part of the person taking them. Whether they work or not any better than placebo is a question the researchers raised, but could not answer in this study.

What the study shows then is what anyone who looks at the mental health marketplace would predict, taking into account the new medications that went on the market during the study period, and those that went generic — psychiatric medication prescriptions rise, while more complicated psychotherapy treatments decline. Why don’t more people use psychotherapy? The researchers guessed that:

[... F]inancial factors including out-of-pocket costs to patients and comparatively low third-party clinician reimbursement for psychotherapy have likely led to declining use of psychotherapy.

Perhaps with the passing of the mental health parity act last year combined with studies that show mental health treatment parity is not that expensive, we’ll see an uptake in psychotherapy treatment in the future.

But ultimately, mental health care is a marketplace. And like any marketplace, the consumer (or client, or patient, if you will) is in charge. The market will provide for them whatever they demand, for better or worse.

Read the full article: Antidepressant Use Up 75 Percent

Dr. John Grohol is the CEO and founder of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

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    Last reviewed: By John M. Grohol, Psy.D. on 4 Aug 2009
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