The use of legal psychoactive drugs has increased twenty two percent in the nine years between 2001 and 2010. This is a truly staggering increase. Most of the increased prescribing is performed by general practitioners-not psychiatric physicians. Most people do not realize that psychiatrists attend medical school like other physicians. After they graduate, psychiatrists receive special training within the field of mental health. Non-psychiatric physicians have a few months of study and clinical training in mental health. This is not intended to demean medically oriented physicians. One can master only so much in a limited amount of time. Most of the problem is not the limited training of physicians, rather it is the beliefs held by the public at large.
Many medically-oriented physicians believe particular patients would gain more from psychotherapy than medication; however, most patients are taken aback by a psychology referral. Patients may believe that the doctor secretly thinks they are crazy or beyond the help of medication(s). In addition, most people believe that psychotherapy takes years, or even a lifetime, to be effective. It evokes images of the psychoanalytic couch, or worse, the snake pit of inpatient treatment. Perhaps the psychologist will discover a hidden psychosis; a primal fear of many normal people. Perhaps the psychologist seeks to relive one’s horrid memories until they are no longer able to function. What about the fear of entrusted secrets to a near stranger? Perhaps the psychologist discusses their crazy patients as entertainment. Once the information is poured out of the bottle, who can say where all the drops will collect.
The beliefs of many psychologists may also interfere with the use of psychotherapy over medications. A lauded professor of psychology, as well as practicing clinician, bemoaned the invention of Prozac as the death of psychotherapy. This was bemoaned in 1990, long before the limitations and risks of the new antidepressants became known. It is often difficult for the clinician to see progress in some patients, such that the use of a magic substance is very attractive. The doctor would feel more secure and effective with something that promises to accelerate the relief experienced in the office. Early research suggested that psychotherapy is only effective for mild cases of anxiety or depression, and many clinicians still believe this to be true. If medication was truly more effective than psychotherapy, psychologists would be guilty of misleading the public at large. The outpatient practice of psychotherapy would effectively be a conspiracy against the public.
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Perhaps the easiest explanation for the rise of drug treatment is that insurance reimbursement for psychotherapy is lower and harder to obtain than that for drugs. From the mid 1990’s to the mid 2000’s, the drug companies tripled their marketing of psychoactive drugs. It has shaped the perceptions of the American public, and likely many professionals as well. The drug companies do not have to make deceitful claims about their products. Saturating the airwaves with pictures of happy attractive people taking their medications is sufficient to mold the unconscious mind. Saturating the airwaves with happy attractive psychotherapy patients is not likely to occur in the near or distant future. No one individual or company would profit from the endeavor. There is no market pressure to push psychotherapy, such that it is shoved to the sidelines.
Convincing people to buy what they don’t need is at the center of American marketing genius. The public apprehension regarding psychotherapy and psychologists energizes and assists the marketing of drugs. Few patients weigh the benefits of psychotherapy over medication, since they are not presented with useful information. Just as the nation woke from a Valium haze in the 80’s, the public is beginning to realize it has been oversold. Wake up and evaluate the options for mental health treatment-you may be pleasantly surprised.
A recent review on the prevention of depression was featured in the May issue of the American Psychologist. The study authors (Munoz, Beardslee and Laykin) were decidedly positive in their appraisal of current prevention efforts. As the authors point out, prior to the 1980’s, it was the official position of the mental health gods that depression was not preventable. The last two decades have seen a reversal of this thinking. Psychologists from around the world have researched programs designed to prevent depression in the general population. Most of the prevention studies cited by these and other authors share many commonalities. First, the research subjects are randomly assigned to treatment and no-treatment groups. Second, the treatment group receives a course on the identification and reduction of depressive symptoms. The depression group intervention varies from a traditional lecture format to group therapy with an identified leader. Lastly, the prevention studies compare symptoms of depression at the beginning of the study with symptoms experienced at the end of the study. The authors then write a report summarizing their positive or negative findings.
Though their intent is certainly noble, the depression prevention researchers have encountered problems with methodology. The first problem is with the method to recruit and classify the study subjects. In order to lower the total number of subjects needed to complete the study, psychologists often use “at risk” individuals to populate the study. The term “at risk” has several meanings in the context of psychological research of this nature. A research subject may have experienced a prior depressive episode, there’s a family history of depression, they live in poverty, or the subject endorsed subclinical elevations on depression questionnaires. Subclinical refers to the manifestation of an abnormal number or type of symptom(s), yet they fail to meet the criteria of a known clinical condition. Unfortunately, the use of “at risk” people lessens the statistical power of the study. No longer are the study subjects randomly assigned to groups, but selected because of a particular trait. The psychologist cannot then compare the depression intervention to the general population, rather the comparison may only be drawn to other “at risk” groups.
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It is certainly the author’s hope that depression is at least partially preventable. Many of the current interventions in use may be valuable, but the present design of these studies limits the power to draw accurate conclusions. Larger study sizes, that are truly randomized, should be combined with sham group interventions. Until there is an increased mindfulness of proper investigatory techniques, the current depression prevention results are not convincing. Stated another way, the correct prevention techniques may already exist, but hard evidence of their effectiveness is lacking. Let us all hope that psychological researchers discover effective methods to prevent depression, as it would not only benefit commerce, but our everyday social experience as well.
Anxiety, Depression, Psychology | orlandopsychcom | 
June 21, 2012 2:29 pm | 
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