Antidepressant use rises while psychotherapy declines
Research Activities, January 2010, No. 353
From 1996 to 2005, the annual rate of antidepressant treatment for U.S. individuals 6 and older rose from 6 percent to 10 percent, while the number being treated increased from 13.3 million to 27 million. This trend made antidepressants the most widely prescribed class of medications in office-based and hospital outpatient-based medical practice, according to Mark Olfson, M.D., M.P.H., of Columbia University, and Steven C. Marcus, Ph.D., of the University of Pennsylvania. Their study of national trends in antidepressant use was based on data from the Agency for Healthcare Research and Quality's (AHRQ's) Medical Expenditure Panel Surveys conducted in 1996 and 2005.
During this period, the percentage of those being treated with antidepressants who were also receiving psychotherapy declined from 32 to 20 percent. Among persons treated with antidepressants, use of newer selective serotonin reuptake inhibitors became increasingly common and use of the older tricyclic antidepressants became less common. A growing percentage of antidepressant users were treated with antipsychotic medications (from 5.4 percent in 1996 to 8.9 percent in 2005), while a declining percentage received inpatient treatment or psychotherapy for a mental disorder.
These trends vividly illustrate the extent to which antidepressant treatment has gained acceptance in the United States and the growing emphasis on pharmacologic rather than psychologic aspects of care, note the researchers. They suggest that the declining use of psychotherapy may be due to financial factors, such as out-of-pocket costs to patients and comparatively low insurance coverage for psychotherapy. Another possible factor is patient perception of the greater effectiveness of antidepressants than psychotherapy.
Use of antidepressants among blacks and Hispanics in 2005 was less than half the rate of whites. Blacks were the only group who did not experience a significant increase in antidepressant treatment. These differences have been thought to be related to racial/ethnic variation in access to mental health services, educational factors, trust of mental health services, and treatment acceptability. This study was supported by AHRQ (HS16097).
See "National patterns in antidepressant medication treatment," by Drs. Olfson and Marcus in the August 2009 Archives of General Psychiatry, 66(8), pp. 848-856.