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 of mental health care, Olfson says. "The research suggests higher rates of depression among people of Hispanic ancestry than among African Americans and whites, and there are also higher rates of depression among the poor and those with low levels of formal education," Olfson says. "There has been an increase in treatment among all of these groups, which is a welcome development. But the unmet need for treatment is still great." Healthcare providers who are not mental-health specialists have been instrumental in the move toward drug therapy for depression. Studies indicate that as many as half of those seeking help for depression are treated by such providers.

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