Depression: Drug v. Talk Therapy

Whether it's talk therapy or drug therapy, getting help for depression or anxiety helps, Americans say. But one appears to work faster, while the other may be more effective.

The survey is a snapshot of the common American's experience with mental health therapy — and the second such survey published by Consumer Reports. The 1995 report "has been cited in textbooks and is considered a landmark study with worldwide impact," said Joel Gurin, Consumer Reports executive vice president, in a news teleconference Tuesday.

"We think this newest study is just as important," he added.

"We hope our study will call attention to the need for further research of a large-selling category of drugs, one that millions of people are taking." Gurin said. "Depression, anxiety, and other mental health problems can be as debilitating as any serious physical illness. But there really is not enough information about the risks and benefits of different treatments."

During the past decade, "the biggest change ... has been the dramatic shift from talk therapy to drug therapy for mental health problems," he noted. "In 1995, less than half of people getting mental health treatment — 40 percent — got drug therapy. Now 68 percent get drug treatment, and 80 percent of those treated for depression or anxiety get drug treatment."

However, the drugs "have some serious side effects ... that seem to be much more common than people realize ... much more common than you might think from seeing drug ads and from reports on drug studies," Gurin said.

The link between antidepressants and suicide rates among children and adolescents is "a very serious issue" that both Congress and the FDA are investigating in hearings, he noted. An FDA panel is meeting next week to determine if there is an increase in suicide and suicidal thoughts among kids taking antidepressants. The agency sent out a warning to doctors last year to be on the lookout for worsening depression or suicidal thoughts in these kids.

Another problem: "Many managed care programs limit mental health treatment to 10 sessions... which may deprive people of the treatment they need."

Drug Therapy vs. Talk Therapy

Researchers based the report on surveys completed by more than 3,000 Consumer Reports readers, and is published in the magazine's October issue.

Specifically, it shows that:

• A combination of talk therapy and drugs worked best for treatment of depression and anxiety. But those whose treatment consisted of mostly talk therapy did almost as well if they had 13 or more visits with the therapist.
• Treatment consisting of mostly drug treatment was also effective for many people. Drugs had a quicker impact on symptoms than talk therapy, but it often took trial and error to find a drug that worked without undesirable side effects.
• More than 50 percent of survey respondents who took antidepressants tried two or more drugs; 10 percent tried five or more. "It really does have to be a process of trial and error ... because there's no predicting people's response to [antidepressants]," says Nancy Metcalf, a Consumer Reports senior editor and author of the survey.
• Side effects were much more common than noted on the medications' package information: 40 percent said they experienced a loss of sexual interest or performance, and almost 20 percent said they gained weight. Why the discrepancy? In clinical trials, people are not asked specifically about certain side effects, Metcalf tells WebMD. "They were expected to volunteer the information, and they may not be as willing to do that."
• Treatment from primary care doctors was effective for people with mild problems, but less so for people with more severe ones. Treatment by mental health specialists yielded significantly better results for people who started out in poor shape.
• Health insurance plan limits on therapy visits and costs kept some people from getting the best treatment.
• Consumers who did their own research and monitored their own care reported better results.
• More than 80 percent of survey respondents said they found treatment that helped.

Many Routes to Good Care

"What comes through overall — there are many routes to good care, but it takes flexibility and persistence to get there," says Metcalf. "The more committed to your own care, the better off you'll be — whether that means finding a different therapist, cutting through red tape with your mental health coverage, or applying what you learn in therapy to your life."

"Some companies do what's called a 'carve-out' mental health coverage, which means they contract it over to another company," she tells WebMD. "If you call the 800 number on your health plan card, you may get someone who doesn't know very much about your mental health coverage. That's where persistence pays off. You really need not give up until you find someone who knows about your health plan. Mental health coverage is often very different from health coverage."

Important note: Under the Americans With Disabilities Act, an employer cannot discriminate against an employee getting mental health care, Metcalf adds. "There are also restrictions as far as how much information your therapist can turn over. Your health care plan knows about drugs you are taking, and very generally about your condition. But they do not have access to personal notes made by your doctor — the most private information. That is legally protected."

Also encouraging is "there has been a lot of effort in the last five or 10 years to bring primary care doctors up to speed about depression, and either treat [patients] or refer them to a mental health professional," Metcalf says. "The most important point is to get help somewhere ... and get it promptly."

Many types of mental health professionals can provide excellent therapy, she notes. The survey showed that whether they saw a psychiatrist, a psychologist, or a social worker, patients had equally good results. How to choose your therapist? "It's largely personal preference," Metcalf tells WebMD. "Just keep in mind, if you go to see a psychiatrist, you are much more likely to get medication. Psychologists and social workers provide talk therapy ... and they can be more cost-effective if you pay out of pocket, which many of our respondents did."

"Many insurers refuse to allow psychiatrists to do anything but prescribe drugs, except for the most severely ill patients," notes Bruce Schwartz, MD, in the report. He is associate professor of clinical psychiatry at Albert Einstein College of Medicine in New York City and one of two consultants who helped design the survey and interpret the results.

SOURCES: Consumer Reports teleconference, Sept. 7, 2004. Consumer Reports, October 2004, pp 22-29. News release, Consumer Reports.

By Jeanie Lerche Davis
Reviewed by Michael W. Smith, MD
By Jeanie Lerche Davis
Reviewed by Michael W. Smith, MD
© 2004, WebMD Inc. All rights reserved