Pills or Therapy?

from http://www.theglobemail.com/ and the Aug issue of Archives of General Psychiatry
Pills taking over from psychotherapy
JULIE STEENHUYSEN
Reuters
August 4, 2008 at 4:30 PM EDT

CHICAGO — U.S. psychiatrists are trading in the analysis couch for a prescription pad, a study released on Monday says after finding that 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 Dr. 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 only 29 per cent of office-based visits to psychiatrists involved psychotherapy in 2004-5, down from 44 per cent in 1996-97.

One major impact is that patients who need to receive psychotherapy must obtain it from other professionals, if they can get it at all, dr. 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," Dr. 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."

He 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.

Dr. Plakun said in a telephone interview that 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 Dr. 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.

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

"Psychologists and social workers are more likely to provide short-term cognitive behavioural therapy," which focuses on changing harmful behaviours, 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," Dr. Mojtabai said.

I was discussing this very topic recently in an interesting discussion with someone who had been a recipient of pills (speed, yes speed - yeah I know its called Ritalin - (http://www.pbs.org/merrow/repository/Television/Past/_attn/guide.html), for ADD in increasing doses and an antidepressant that killed her sex drive) from a psychiatrist. Now completely pill free, she had to literally fight to get her life and her mind back from those lost years. This article is just confirming what is already fairly well known in the general public. See a pyschologist first and only see a psychiatrist if what you have is truly a mental condition that can ONLY be treated by drugs.