The use of anti-depressant medications nearly doubled between 1996 and 2005, according to an analysis published in the August issue of the Archives of General Psychiatry.

In 2005, 10.1% of Americans used anti-depressant meds, compared with 5.8% in 1996.

A key trend underneath the dramatically increased use of anti-depressant meds was the decline in talk therapy (psychotherapy). Nearly 1 in 3 people who used anti-depressants in 1996 were engaged in psychotherapy, but in 2005, only 1 in 5 participated in talk therapy.

Researchers used data from the Agency for Healthcare Research and Quality’s (AHRQ’s) Medical Expenditure Panel Surveys (MEPS), which details longitudinal health care cost and utilization data in the U.S.

The researchers point to several factors that may be driving up the use of anti-depressants:

  • The lessening of taboos surrounding mental health and the use of drugs to treat depression
  • An increase in the prevalence of depression
  • The growth in the number of anti-depressant medication products available on the market since 1996, including some major blockbusters with brand-name recognition
  • Expanded clinical guidelines for the use of these medications.
Health Populi’s Hot Points: That social acceptance of depression in society has grown is a positive trend. Early diagnosis and treatment of depression can add quality of life to peoples’ daily living, increasing productivity, preserve relationships, and be a win-win for both the individual and the larger public health picture.

However, the decline in talk therapy can be concerning. Wholesale replacement of face-to-face clinical encounters with easy-to-prescribe pills may not always be the best medicine for a clinically depressed person.

One of the key factors that causes people with depression to not seek therapy is the issue of payment, or reimbursement to the psychotherapist. Mental health services in the U.S. still lack purchasing parity, as it were. Many people even with health insurance have very limited access to counseling and psychotherapy, making medication prescribing by physicians their only source of mental health ‘care.’

A hopeful alternative to face-to-face psychotherapy are found in Web 2.0 platforms like tele-therapy in groups or singly, Second Life and other venues that lower the cost of therapy led by a clinical expert. Dr. Dan Hoch, a neurologist in Boston and the founder of BrainTalk Communities, has leveraged online platforms for neurology patients around the world. Second Life has provided a place for therapists to meet with patients; veterans from the Iraq War have met in groups, virtually, to deal with post-traumatic stress syndrome.

In our new world of looking for cost containing strategies while serving the public’s health, creative solutions to deal with depression should look beyond the pill for some patients who might be treatment-resistant or need complementary therapies.

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