Prescribing Pills Rather than Psychotherapy

In an era where mental health care decisions are made according to what HMOs and other insurers will pay for, the "quick fix" reigns supreme. As someone going into the mental health field, I find this highly disturbing. Obviously, medications have an important role to play, but they treat the symptoms. not the cause.

I know many will argue that some issues, such as depression, bipolar, ADHD, and so on, are biologically based. Yeah, maybe, but it's a chicken and egg issue. Someone may be born with a genetic predisposition to becoming depressed, but it takes an environmental trigger, most times, to activate the genes.

So when it comes to treatment, an antidepressant might reduce the symptoms, but it doesn't address the environmental situation (say divorce, job loss, or, at the extreme, childhood abuse) that triggered the genes. These environmental influences "rewire" the brain in certain ways that can be changed through traditional talk therapy, including more recent therapies like CBT, and other cognitive approaches.

But this all seems to be going out the window in favor of prescribing pills that therapists know the insurance agencies will pay for, as reported by Reuters:

Move over Freud: Psychiatrists embrace pill power

By Julie Steenhuysen

CHICAGO (Reuters) - Psychiatrists in the United States are trading in the analysis couch for a prescription pad, according to a study released on Monday that found fewer psychiatrists offer psychotherapy.

The shift to briefer visits for medication management, reported in the Archives of General Psychiatry, appears to be linked to better psychiatric drugs and pressure from managed care companies, which offer richer financial incentives for brief office visits.

"Psychiatrists get more for three, 15-minute medication management visits than for one 45 minute psychotherapy visit," said Dr. Ramin Mojtabai of Johns Hopkins University in Baltimore and formerly of Beth Israel Medical Center in New York, where he did the research.

Various forms of psychotherapy, either alone or in combination with medications, are recommended to treat depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.

Yet Mojtabai and colleagues, who analyzed data from national surveys of office-based psychiatrist visits from 1996 through 2005, found a significant drop in the number of office-based psychiatrists providing psychotherapy.

He said just 29 percent of office-based visits to psychiatrists involved psychotherapy in 2004-5, down from 44 percent in 1996-97.

One major impact is that patients who need to receive psychotherapy must get it from other professionals, if they get it at all, Mojtabai said in a telephone interview.

That can result in disjointed service, in which a patient sees a psychologist or social worker for therapy and a psychiatrist or a general physician for drugs.

"Whether it has any impact on the outcome of the disorder, we don't really know," Mojtabai said. "I don't think necessarily that it is harmful. It might not be as efficient."

BRAIN AGE

Dr. Eric Plakun, who leads an American Psychiatric Association committee on psychotherapy, said he noticed a shift away from psychotherapy beginning about 10 years ago, when more psychiatrists began to embrace "the age of the brain."

Plakun said medical schools began to focus more on the biology of mental illness than on traditional psychotherapy and that is now reflected in practices across the United States.

Plakun said in a telephone interview it is not clear if patients are getting therapy from other providers, or not at all.

"Either way, I'm worried about our patients," he said. "Patients need the best help we can give them."

For Plakun, that means offering a range of services, including psychotherapy, and not just medication. "If all you have is a hammer, everything looks like a nail," he said.

Mojtabai thinks patients are getting therapy from others, but said the focus is likely different from the analysis psychiatrists have traditionally offered.

"Psychologists and social workers are more likely to provide short-term cognitive behavioral therapy," which focuses on changing harmful behaviors, he said.

As for the type of analysis featured in movies, particularly in Woody Allen films, it is available -- to a very few.

"If you have some hard feelings about your childhood and you live in New York and have a lot of money, you can still find psychiatrists who provide long-term psychotherapy," Mojtabai said.

Tags: Prescribing Pills, Psychotherapy, Psychology, culture, Health, psychiatry, medicine, insurance, talk therapy, psychologists