Treatment Of Depression
Q: A new study finds that more people than ever are seeking treatment for
depression, but over the past decade, the care people receive has been
changing. Fewer people are telling their troubles to therapists, and
more are receiving antidepressants to improve their mental health.
A:Comparing data from two large national surveys, researchers found the
following trends:
* Three times as many Americans sought outpatient treatment for
depression in 1997 as in 1987.
* Antidepressant use doubled during the 10-year period among
patients seeking treatment.
* A total of 74% of patients used drugs to treat their depression
in 1997, compared to 37% a decade earlier.
* Among those seeking treatment, the proportion receiving
psychotherapy declined from 71% to 60% during the 10-year period. And
the average number of visits to a therapist declined from 12.6 in 1987
to 8.7 in 1997.
"It is clear that fewer people are receiving psychotherapy, but it is
difficult to say what that means in terms of quality of care," lead
author Mark Olfson, MD, MPH, tells WebMD. "I think it is an unresolved
issue that will require more study." Olfson and colleagues from the New
York State Psychiatric Institute published their findings in the Jan. 9
issue of The Journal of the American Medical Association.
Not surprisingly, depression care shifted away from therapist-oriented
approaches as a widely embraced class of drugs became available to treat
the condition. The first selective serotonin reuptake inhibitor (SSRI)
was introduced in 1987, and now millions of Americans take drugs like
Prozac, Paxil, Zoloft and Celexa to treat a wide range of depressive
illnesses.
Olfson and colleagues suggest a federal public health initiative begun
in 1987 may have helped to destigmatize depression. The campaign was
designed to educate the public and physicians about the recognition and
treatment of depression.
It is estimated that 5% to 10% of Americans suffer from major depression
in any given year. The surveys indicated that fewer than 1% sought
treatment for depression in 1987 and 2.3% sought treatment in 1997.
"It is certainly encouraging that more people are being treated, but we
are still treating just 20% to 25% of those in need," psychiatrist
Kenneth B. Wells, MD, MPH, tells WebMD. "There is still a stigma
surrounding mental illness, despite public efforts." Wells is a
professor of psychiatry at the UCLA Neuropsychiatric Institute and also
is a senior scientist at the California think tank RAND (which stands
for research and development).
He says many people still do not seek treatment for depression because
they cannot afford it. Olfson and colleagues found treatment costs to be
covered more often by third-party payers in the 1990s. But other studies
suggest mental health coverage is on the decline, especially for
psychotherapy.
The surveys showed a low, but rising, rate of treatment among blacks and
Hispanics; those with lower education levels; and those without health
insurance. This population appears to be especially under-served in
terms