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Among people receiving treatment for depression
in the US, the percentage of those on antidepressant medication
has risen dramatically, while fewer are opting for time on
the couch in psychotherapy.
The number of Americans treated for depression
soared from 1.7 million to 6.3 million between 1987 and 1997,
and the proportion of those receiving antidepressants doubled.
The researchers attributed the sharp increases
to the emergence of aggressively marketed new drugs like Prozac,
the rise in managed care and an easing
of the stigma attached to the disease.
The study found that the share of patients
who used antidepressant medication climbed from 37% to nearly
75%. At the same time, the proportion
who received psychotherapy declined from 71% to 60%.
The publicizing of newer antidepressants
that have fewer side effects - such as Prozac, which was introduced
in late 1987 - has helped make patients more willing to seek
treatment, the researchers said. This publicity has included
pharmaceutical industry efforts to market the drugs directly
to consumers and public-awareness campaigns about depression.
The rise in managed care also has contributed
to the increase in use of medication, which may be less costly
and time-consuming than psychotherapy, the researchers said.
Managed care also has placed more emphasis
on primary-care physicians, who may be more likely to prescribe
medication than to refer patients to specialists for psychotherapy,
said Ronald Kessler, a professor of health care policy at
Harvard University who was not involved in the study.
Kessler said evidence shows that combining
medication with psychotherapy is the most effective treatment
for depression. While many of the patients studied received
both, some clearly did not, and Kessler said the findings
do not indicate whether patients received adequate treatment.
In the US, experts estimate that during
any given year, between 5% and 10% of the population experiences
major depression, according to the report.
And more people are being treated for
depression than ever before, the study finds, suggesting that
the stigma associated with depression may be declining.
The last decade also saw a huge increase
in the advertising of these newer medications, the researchers
point out, as well as a considerable amount of media coverage
of depression.
JAMA January
9, 2002;287:203-209
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