Psychiatrists prescribing more drugs than therapy for patients

Psychiatrists in the U.S. increasingly provide patients with drugs rather than psychotherapy as health insurance plans cut costs, researchers found, and the head of an American Psychiatric Association panel said patients may be "suffering."

A study of more than 14,000 psychiatry sessions showed the percentage of visits involving psychotherapy fell to 28.9 percent in 2005 from 44.4 percent in 1996, said researchers at Beth Israel Medical Center and Columbia University in New York.

The use of medication rose to 83.8 percent of cases from 68.6 percent, according to the study, published in the Archives of General Psychiatry.

While lead author Ramin Mojtabai said there isn't any evidence the development has hurt patients, Eric Plakun, chairman of an American Psychiatric Association committee, said a shift in the balance between medication and psychotherapy may harm people.

"Both psychotherapy and psychopharmacology work synergistically," said Plakun, the head of the Arlington, Virginia-based association's Committee on Psychotherapy by Psychiatrists.

"If it's true that there is a diminution of psychotherapy to patients, then I think it's our patients that are suffering."

The rise of managed care has limited the number of visits a patient can make to a psychiatrist, leading to an increased focus on medication, said Plakun, who practices in Stockbridge, Massachusetts and wasn't involved in the study.

For psychiatrists, the payment plans make prescribing medications a more lucrative alternative to psychotherapy, said Mojtabai, now an associate professor in the Department of Mental Health at Johns Hopkins University in Baltimore.

The study cites research showing that benefit managers' reimbursement for a psychotherapy session lasting about 45 minutes was more than 40 percent lower than for three 15-minute medication-management appointments.

"There has been a shift in psychiatry from the psychotherapeutic and psychological to the biological," Mojtabai said in a telephone interview on Aug. 1.

"Fewer and fewer psychiatrists are going into psychotherapy as a specialized profession and more are going into pure medication management."

Patients are increasingly receiving drugs from psychiatrists and therapy from nonmedical professionals, Mojtabi said.

The study was funded by the Rockville, Md.,-based Agency for Healthcare Research and Quality, a branch of the U.S. Department of Health and Human Services.

Mojtabai has received previous funding from pharmaceutical companies Bristol-Myers Squibb Co. in New York and AstraZeneca PLC in London.