Move Over, Couch: Psych Pills Take Over

Aug. 4, 2008— -- CHICAGO (AP) - Cartoons about the psychiatrist's couch wererecently the subject of a museum exhibition. Now, the couch itselfmay be headed for a museum.

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

The expanded use of pills and insurance policies that favorshort office visits are among the reasons, said lead author Dr.Ramin Mojtabai of Johns Hopkins Bloomberg School of Public Healthin Baltimore.

"The 'couch,' or, more generally, long-term psychoanalyticpsychotherapy, was for so long a hallmark of the practice ofpsychiatry. It no longer is," Mojtabai said.

Today's psychiatrists get reimbursed by insurance companies at alower rate for a 45-minute psychotherapy visit than for three15-minute medication visits, he explained.

His study found that the percentage of patients' visits topsychiatrists for psychotherapy, or talk therapy, fell from 44percent in 1996-97 to 29 percent in 2004-05. The percentage ofpsychiatrists using psychotherapy with all their patients alsodropped, from about 19 percent to 11 percent.

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

As talk therapy declined, TV ads contributed to an "aura ofinvincibility" around drugs for depression and anxiety, saidCharles Barber, a lecturer in psychiatry at Yale University andauthor of "Comfortably Numb: How Psychiatry is Medicating aNation."

"By contrast, there's almost no marketing for psychotherapy,which has comparable if not better outcomes," said Barber, who wasnot involved in the study.

The findings, published in Monday's Archives of GeneralPsychiatry, 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 analyzedthose psychiatrist visits.