Tuesday, August 5, 2008

Psychiatry becomes pill pushing... as if you didn't know

Not that it's a surprise to anyone, but the AP is reporting that psychotherapy is in decline in favor of drug treatments.

His study found that the percentage of patients' visits to psychiatrists for psychotherapy, or talk therapy, fell from 44 percent in 1996-97 to 29 percent in 2004-05. The percentage of psychiatrists using psychotherapy with all their patients also dropped, from about 19 percent to 11 percent.

Apparently, the thinking is that insurance companies will pay more for visits to get drugs than for the time it takes the "talking cure" to be effective.

The expanded use of pills and insurance policies that favor short office visits are among the reasons, said lead author Dr. Ramin Mojtabai of Johns Hopkins Bloomberg School of Public Health in Baltimore.

"The 'couch,' or, more generally, long-term psychoanalytic psychotherapy, was for so long a hallmark of the practice of psychiatry. It no longer is," Mojtabai said.

Today's psychiatrists get reimbursed by insurance companies at a lower rate for a 45-minute psychotherapy visit than for three 15-minute medication visits, he explained.

Of course, no mention of health care would be complete without marketing references:

As talk therapy declined, TV ads contributed to an "aura of invincibility" around drugs for depression and anxiety, said Charles Barber, a lecturer in psychiatry at Yale University and author of "Comfortably Numb: How Psychiatry is Medicating a Nation."

"By contrast, there's almost no marketing for psychotherapy, which has comparable if not better outcomes," said Barber, who was not involved in the study.

So, all that talk about "chemical imbalances" ( none of which can be objectively tested for, apparently ) is bunk? Is it all really just a matter of changing one's outlook and actions? Not that that's a simple proposition... but it's not something you need a prescription for.

1 comment:

TchoTChoWrangler said...

Remember a while back we had a conversation about rationing in the NHS and I argued the story you used wasn't really about rationing. Well try this one for size...


As I understand it the drugs are readily available in the US and Europe, and up until NICE's decision available in some NHS trusts.