- Trends in Treatment
By Terence T. Gorski
January 9, 2001
The number of Americans treated for depression soared from 1.7 million to
6.3 million between 1987 and 1997. There are strong indicators that
the number of people seeking treatment for depression continued to
increase from 1997 to 2000.
About 5 percent of the U.S. population roughly 14 million people
could benefit from treatment for depression.
About 2.5% of Americans, approximately 7 million people, are treated for
depression each year. This
is only about half the number of people who could benefit from treatment.
There is strong evidence suggesting that :
Cognitive Behavioral Therapy (CBT) for Depression is just as effective
as medication management in the treatment of depression, but the two types
of treatment tend to work best with with different types of depression.
In other words CBT for Depression is effective with some patients who are
not helped by antidepressant medication and antidepressant medication is
effective with some patients who are not helped by CBT for Depression;
The most effective treatment for depression involves the combination of
CBT for Depression and antidepressant medication.
Between 1987 and 1997 the proportion of patients who
used antidepressant medication climbed from 37 percent to nearly 75
Between 1987 and 1997 the proportion who
received psychotherapy declined from 71 percent to 60 percent.
These trends in the treatment of depression can be attributed to the
#1: Development of the SSRI's: The development of
Selective Serotonin Reuptake Inhibitors (SSRI's), a new generation of
antidepressant medications with fewer side effects than the previous
generation of tricyclic antidepressants.
#2: The Aggressive Marketing of the SSRI's: The aggressive
marketing of the SSRI's to managed care organizations, primary care
physicians, and consumers. The general media advertising for the
SSRI's has been designed to educate the general population about the
symptoms of depression, describe depression as a medical illness, explain
that the SSRI's can be used as an effective treatment, and encourage
people to discuss problems of depression with their primary care physician
and request medication.
#3: The Easing of Stigma: The stigma associated with
depression is easing which makes more people willing to admit to
themselves that they are depressed and seek treatment.
#4: The Ineffective Marketing of Psychotherapy for Depression:
Psychotherapy has not been recognized as a preferred treatment for
depression by managed care organizations, primary care physicians, or the
general population of consumers even thought strong evidence shows that
the most effective treatment for depression combines Cognitive
Behavioral Therapy (CBT) for Depression with antidepressant medication
and that Cognitive Behavioral Therapy (CBT) for Depression can be
effective for some depressed patients who do not benefit from
antidepressant medication. This is because psychotherapy has not
been aggressively or effectively marketed.
#5: The Influence of Managed Care Organizations: Managed
Care organizations have had a large impact upon the identification and
treatment of depression. Most managed Care Organizations (MCO's)
encourage the early identification and treatment of depression using
appropriate medications. Most MCO's prefer medication management as
a more cost-effective alternative to either hospitalization or outpatient
psychotherapy. As a result, they are more likely to refer to
primary-care physicians who use medication to treat depression than to
refer to psychotherapists who specialize in depression treatment.
#6: The Increased Involvement of Primary Care Physicians:
More primary care physicians are getting involved in the treatment of
depression. The aggressive marketing of antidepressant medications
is convincing more people that depression is a legitimate medical problem
that can be effectively treated. As a result, more people are asking
their primary care physicians to treat their depression with
medication. Primary care physicians have a financial incentive to identify
and treat depression in their patients because most managed care
organizations are willing to pay for medication management .
Mark; Marcus, Steven C.; Druss, Benjamin; Elinson, Lynn ; Tanielian, Terri
MA; and Pincus, Harold Alan; National
Trends in the Outpatient Treatment of Depression, JAMA.
January 9, 2002; 287:203-209
Lindsey, Treatment for Depression Soars, Associated Press (AP),
January 9, 2002 <Read The Article>