PSYCHIATRISTS PRESCRIBE PILLS, DO NOT MAK USE OF PSYCHOTHERAPY

CHICAGO - Cartoons about the psychiatrist’s couch were recently the subject of a museum exhibition. Now, the couch itself may be headed for a museum.

A new study finds a significant decline in psychotherapy practiced by U.S. psychiatrists.

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.

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.

Psychiatrists who provided talk therapy to everyone had more patients who paid out of pocket compared to those doctors who provided talk therapy less often. And they prescribed fewer pills.

'Aura of invincibility' around meds
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.

The findings, published in Monday’s Archives of General Psychiatry, are based on an annual survey of office visits to U.S. doctors. Of more than 246,000 visits sampled during the 10 years, more than 14,000 were to psychiatrists. The researchers analyzed those psychiatrist visits.