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Psychotherapy Losing Ground To Medications

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Los Angeles Times

Published: August 5, 2008

Wider use of antidepressants and other prescription medications has reduced the role of psychotherapy, once the defining characteristic of psychiatric care, according to an analysis published Monday.

The percentage of patients who received psychotherapy fell to 28.9 percent in 2004-2005 from 44.4 percent in 1996-1997, the report in Archives of General Psychiatry said.

Researchers attributed the shift to insurance reimbursement policies that favor short doctor visits to discuss and prescribe medication compared with longer psychotherapy sessions, and the introduction of a new generation of psychotropic medications with fewer side effects.

Although not a surprise to many psychiatrists, the findings were expected to intensify a debate over the increased use of drugs for psychiatric care, which in part reflects an emphasis on the biology of mental illness, as compared with the processes of the mind.

Psychotherapy is an interpersonal intervention that might involve behavior modification and group discussion. It is recommended - with or without medication - for major depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.

Besides psychiatrists, a range of mental health professionals not covered in the report also conduct psychotherapy, including psychologists, social workers and marriage counselors.

The study was based on data drawn from the National Ambulatory Medical Care Survey, an anonymous survey of office-based physicians that tracks characteristics of patients and physicians, and records the diagnosis and treatment, during a typical week.

Researchers examined data on 14,108 psychiatric office visits during a 10-year period.

Psychiatrists who said they provided psychotherapy to all their patients declined to 10.8 percent in 2004-2005 from 19.1 percent in 1996-1997.

Consistent with previous studies, researchers found that patients who paid out-of-pocket, generally the wealthiest patients, were more likely to receive psychotherapy.

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