Despite Questions about Antidepressant Effectiveness, Some Doctors Are Prescribing More

Philadelphia, PAWith lawsuits concerning Paxil side effects, such as Paxil birth defects, bringing focus on the effects Paxil allegedly has on unborn babies, some patients might find it unnerving that more psychiatrists are turning to drugs to treat their patients. This despite a study that suggests some antidepressants are barely more effective than a placebo and regardless of recent Paxil lawsuits alleging the antidepressant can cause lifelong effects on babies who are exposed to it.

But The New York Times (Harris, 03/05/11) reports that some psychiatrists are eliminating talk therapy and putting their patients directly on medication, sometimes after only a brief consultation. In fact, the article notes that in the past, when psychiatrists focused on talk therapy, they might treat 50 to 60 patients in sessions that lasted about 45 minutes. Those psychiatrists who focus only on drug treatment, however, treat up to 1,200 patients in visits that last 15 minutes.

And, while talk therapy patients would see their psychiatrist once or twice a week, patients of drug-only psychiatrists might see their psychiatrists every few months, simply to adjust their medication. And, where psychiatrists who use talk therapy might have taken 10 sessions or more to arrive at a diagnosis, psychiatrists who use prescriptions only often come at a diagnosis at the end of the first session.

Part of the problem, according to the article, is that insurance companies reimburse less for a talk therapy session than they do for medication visits.

Some patients say antidepressants and other drugs help them, but a paper published in the August 2010 issue of Psychotherapy and Psychosomatics (Pigott, et al. 07/09/10) suggests that antidepressants are only marginally better than placebos at treating depression. The paper analyzed the results of a study called Sequenced Treatment Alternatives to Relieve Depression (STAR*D), which had previously been touted as proving antidepressants are useful in treating depression.

Researchers for the Psychotherapy and Psychosomatics paper, however, argue that patients were included in the study even though they had minor depressive disorder when the study was meant to examine patients with major depressive disorder. Furthermore, they argue, 320 patients were excluded from the study but later included in it with no score on the Hamilton Rating Scale for Depression.

Researchers examining the STAR*D results found that only 2.7 percent of participants experienced a sustained benefit from taking a Selective Serotonin Reuptake Inhibitor (a class of antidepressant that includes Paxil). They concluded that antidepressants "fail to result in sustained positive effects for the majority of people who receive them," but did note that there are some people who receive a benefit from antidepressants.