Trends in treating depression favor psychotropic medications over psychotherapy

Research Activities, July 2011, No. 371

The way depression is treated in the United States has changed over the past 20 years. Between 1987 and 1997, significantly more people were treated for the condition as outpatients. During this time, the use of psychotherapy declined, replaced by antidepressant medications. In 1987, 37.3 percent of outpatients treated for depression received antidepressant medications. By 1997, it had doubled to 74.5 percent. In two recent studies, researchers from Columbia University and the University of Pennsylvania looked at the next decade from 1998 to 2007 to see if these trends in treating depression continued. Results revealed a continued decline in the use of psychotherapy and stabilization in the use of antidepressants to treat depression. Both studies, supported by the Agency for Healthcare Research and Quality (HS16097), are summarized here.

Marcus, S. C. and Olfson, M. (2010, December). "National trends in the treatment for depression from 1998 to 2007." Archives of General Psychiatry 67(12), pp. 1265-1273.

The researchers analyzed household data from the 1998 and 2007 results of the Medical Expenditure Panel Survey (MEPS). Information collected included diagnoses of depression, use of psychotherapy and psychotropic medications, and background individual characteristics.

The proportion of people undergoing outpatient treatment for depression increased significantly from 2.37 per 100 persons in 1998 (6.48 million) to 2.88 per 100 persons in 2007 (8.69 million). Groups with the largest proportionate increases in treatment included blacks, Medicare patients, and adults with less than a high school education. There was little change in the percentage of depression outpatients who received antidepressants from 1998 (73.8 percent) to 2007 (75.3 percent). However, there was a significant decline in depression outpatients receiving psychotherapy, from 53.6 percent in 1998 to 43.1 percent in 2007. Expenditures for depression treatment increased at the national level, for medications, and for Medicare.

Olfson, M. and Marcus, S. C. (2010, December). "National trends in outpatient psychotherapy." American Journal of Psychiatry 167(12), pp. 1456-1463.

This study used data from the same MEPS in 1998 and 2007. Researchers focused on persons who made more than one outpatient psychotherapy visit during a calendar year. They calculated the percentages of individuals treated only with psychotherapy, only with a psychotropic medication, or a combination of both treatments.

Although the overall percentage of people receiving psychotherapy remained nearly constant from 1998 (3.37 percent) to 2007 (3.18 percent), psychotherapy use significantly declined among people receiving outpatient mental health care. Among this group, use of only psychotherapy fell from 15.9 percent in 1998 to 10.5 percent in 2007; use of psychotherapy and psychotropic medication together declined from 40.0 percent in 1998 to 32.1 percent in 2007; and use of only psychotropic medications increased from 44.1 percent in 1998 to 57.4 percent in 2007. These trends reflect increasing psychotropic medication use with little change in psychotherapy use. Among outpatients receiving psychotherapy, there was a decrease in average number of annual visits from 9.7 (1998) to 7.9 (2007). As a proportion of outpatient mental health expenditures, psychotherapy significantly declined from 71.0 percent in 1998 to 44.7 percent in 2007. Private insurance had the biggest decline in mean expenditures for psychotherapy (27.1 percent decline), followed by self-payment (17.4 percent), and Medicaid (17.3 percent).

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