SUNDAY, Nov. 3, 2002 (HealthDayNews) -- Now that some of the stigma of mental illness has been stripped away, more Americans than ever before are reaching out for help with depression.
But the form that treatment takes is a matter of increasing debate in health-care circles.
The heart of the argument: Are antidepressants being over-prescribed or under-prescribed for those struggling with depression? The answer isn't as simple as you may think.
In a study published recently in the Journal of the American Medical Association, Columbia University psychiatrist Dr. Mark Olfson and his colleagues examined national trends in the outpatient treatment of depression between 1987 and 1997.
Olfson found the percentage of Americans being treated for depression more than doubled during the 10-year period. And the total number of people receiving treatment rose from 1.7 million to 6.3 million.
The researchers also found that patients were almost five times more likely to be treated with antidepressants than they were in 1987.
A number of factors account for the dramatic rise in the use of antidepressants.
Proponents say they are the fastest, most reliable method of delivering much needed relief to victims of a debilitating disease.
"The most robust and rapid response to treatment is obtained from antidepressant medications," says Dr. Barnett Meyers, a professor of psychiatry and clinical epidemiology at Cornell University's Weill Medical College in White Plains, N.Y.
And the newer generations of antidepressants -- called selective serotonin reuptake inhibitors and marketed under such brand names as Prozac, Zoloft and Paxil -- produce less troublesome side effects than older medications.
Further fueling the rise in the use of antidepressants: The proportion of pharmacy costs borne by health insurers increased over the 10-year period of Olfson's study, reducing out-of-pocket costs for consumers.
Depressed patients were also more likely to consult initially with their family physician or a psychiatrist, who would tend to prescribe medication, as opposed to psychologists or social workers who'd be more likely to provide psychotherapy, the study found.
That helps to explain, in part, the sharp decrease in the percentage of people receiving psychotherapy for depression. The researchers found that 60.2 percent of those treated for depression in 1997 received psychotherapy, down from 71.1 percent in 1987. And the average number of psychotherapy visits per patient, per year, also declined from 12.6 to 8.7 over the 10-year span.
The trend toward antidepressants as the treatment of choice is viewed with concern by some mental-health experts.
"The idea that depression is simply some sort of biological error that can be easily fixed by an antidepressant fundamentally shortchanges people," says Dr. James S. Gordon, a psychiatrist who directs the Center for Mind-Body Medicine in Washington, D.C.
"What's happening now appears to be more economical," Gordon adds. "There's a tremendous amount of advertising [by the drug companies]. Doctors are immediately reaching for the prescription pad without thinking of the complexity of the human being sitting in front of them."
Many experts also attribute the shift in treatment options to the rapid growth of managed-care plans and aggressive efforts to reduce health-care costs.
"The Olfson data, indicating that there has been a 50 percent reduction in the use of psychotherapy alone over the 10-year period, probably results from obstacles that insurance companies place as a barrier to obtaining this treatment," says Meyers. He adds that depression is often best treated using a combination of medication and psychotherapy.
"These economically driven barriers can be expected to decrease the number of mental-health practitioners with psychotherapy training, which will further limit access of patients to this treatment," Meyers says. "Research data demonstrating that mild clinical depression may respond robustly to psychotherapy, and that psychotherapy augments the benefits of antidepressants argue that this trend should be reversed."
Major depression affects more than 19 million Americans at any point in time. Current research suggests a combination of antidepressants and cognitive behavioral psychotherapy is the most effective treatment regimen for most forms of major depression. In cases of mild depression, some studies show that psychotherapy can be as effective as medication.
Although depression is a very treatable disease, the majority of depressed Americans receive no treatment at all, according to a 1999 U.S. Surgeon General's study titled, "Report on Mental Health." And a 2001 report by the National Institute of Mental Health concurred, stating that only 25 percent to 50 percent of individuals with anxiety and depressive disorders receive appropriate treatment.
Meyers says that studies from around the world show that when mistreated or left untreated, depression can have devastating consequences. For instance, major depression accounts for 20 percent to 35 percent of all suicides, according to the Surgeon General's report.
"Depression is one of the major public health problems of our country," Gordon says. "We need to look at what's making people depressed and address it in a comprehensive, holistic and individualized way."
"In that mode, drugs certainly have a part, but that's a smaller part than they are playing now," he adds.
What To Do
To learn more about depression, visit the National Institute of Mental Health or the American Psychiatric Association.
