Monitor on Psychology - June 2012 - (Page 38)

States, just after cholesterol-lowering drugs. Most antidepressants are prescribed by primary-care physicians who may have limited training in treating mental health disorders. In the United States, almost four out of five prescriptions for psychotropic drugs are written by physicians who aren’t psychiatrists (Psychiatric Services, 2009). And fewer of their patients receive psychotherapy than in the past. In 1996, one-third of patients taking antidepressants also received therapy. By 2005, only one-fifth of patients did, according to a study of more than 50,000 medical surveys that was coauthored by Mark Olfson, MD, professor of clinical psychiatry at Columbia University (Archives of General Psychiatry, 2009). Lower clinician reimbursement rates for psychotherapy and higher out-of-pocket costs to patients most likely contributed to the declining use of therapy, the study found. “Antidepressants are overprescribed and underprescribed in the United States,” Olfson says. “Many adults with major depressive disorder go for long periods of time without receiving treatment.” At the same time, many people with mild depression are prescribed antidepressants even though they aren’t likely to benefit from the drugs, he added. A growing body of research suggests that antidepressants aren’t as effective as many people believe. An analysis of all FDA clinical trials for four SSRI antidepressants found that the drugs didn’t perform significantly better than placebos in treating mild or moderate depression, and the benefits of the drugs were “relatively small even for severely depressed patients” (PLoS Medicine, 2008). The study was led by Irving Kirsch, PhD, a clinical psychologist and researcher who is now associate director of the Program in Placebo Studies at Harvard Medical School. Some critics have challenged the study’s methodology or cited other studies that support the efficacy of antidepressants. Clinical studies of antidepressants also have some common limitations, including the subjective nature of depression rating scales and the difficulty in studying hospitalized or suicidal patients with severe depression, says Steven Paul, 38 “Antidepressants are overprescribed and underprescribed in the United States. Many adults with major depressive disorder go for long periods of time without receiving treatment.” MD, a neuroscientist who heads the Appel Institute for Alzheimer’s Research at Weill Cornell Medical College in New York City. Paul, who previously served as president of Lilly Research Laboratories, says several studies and his own clinical experience as a psychiatrist showed that a combination of antidepressants and cognitive behavioral therapy were the most effective method for treating depression. “Medication treatment is but one way to treat depression,” he says. “It’s not necessarily the best way or the only way.” Selective publication of clinical trials on antidepressants also could cause a bias about their perceived effectiveness, according to a study led by researchers at the Portland Veterans Affairs Medical Center (New England Journal of Medicine, 2008). The study examined 74 FDA-registered studies for a dozen antidepressants and found that most studies with negative results were not published in scientific literature or were published in a way that conveyed a positive outcome. The FDA studies showed that half of the drug trials had positive results, but 94 percent of the trials cited in published literature were positive. Psychotherapy may be just as effective as antidepressants in MARK OLFSON many cases, without the Columbia University risk of side effects and with lower instances of relapse, according to some studies. Hollon studied 240 patients with moderate to severe depression and found that patients who responded to cognitive therapy were significantly less likely to relapse into another bout of major depression than patients who responded to antidepressants and were later withdrawn from the drugs (Archives of General Psychiatry, 2005). The study also found some enduring effects from cognitive therapy that may help prevent recurrence of depression. “Our impression is that patients initially need to apply the skills they learned during [cognitive therapy] treatment in a concerted fashion, but that these compensatory strategies eventually become second nature,” the study noted. These strategies include having patients examine their negative thought patterns and the creation of a step-by-step plan to help cope with life stresses. MONITOR ON PSYCHOLOGY • JUNE 2012

Table of Contents for the Digital Edition of Monitor on Psychology - June 2012

Monitor on Psychology - June 2012
Letters
President’s column
Contents
From the CEO
Give an Hour founder is one of Time magazine’s ‘most influential’
APA treatment guidelines panels are being formed
APA supports ‘Speak Up For Kids’
In Brief
Time Capsule
Random Sample
Judicial Notebook
Questionaire
APA honors Howell
Science Watch
Science Directions
What you should know about online education
Speaking of Education
Psychologist Profile
Redefining masculinity
Miscarriage and loss
Something for everyone
Candidates weigh in
Division Spotlight
American Psychological Foundation
Personalities

Monitor on Psychology - June 2012