Managed-care cost-cutters increasingly emphasize drugs over psychotherapy even though for some disorders "medication is being pushed without scientific basis," said University of Pennsylvania psychologist Paul Crits-Cristoph.
He and a team of Canadian researchers spoke Thursday at the annual meeting of the Society for Psychotherapy Research. They said an analysis of previous studies indicates psychotherapy is as good as medication for anxiety disorder, major depression and minor depression.The research suggested psychotherapy may be better than drugs for less severe cases of major depression and for "somatoform disorders" in which people suffer pain and other physical symptoms for psychological reasons.
For the disorders analyzed, "the prejudice in certain circles would be to give drugs," said J. Christopher Perry, who heads the research team from Montreal's McGill University and Jewish General Hospital. "We found that is just prejudice. Psychotherapy was as good in most cases, and sometimes better."
Perry and McGill psychiatrists Floriana Ianni, Elisabeth Banon, Nicola Casacalenda and Carmella Roy presented their findings as 350 psychotherapists opened the five-day convention. Their conclusions were based on "meta-analysis," a statistical method of pooling results of numerous studies of varying quality.
Fred Reimherr, a psychiatrist at the University of Utah Mood Disorders Clinic, called the research simplistic for pitting psychotherapy against medication because "people aren't restricted to one or the other."
Perry acknowledged drawbacks to the research. Patients were only followed for several months to two years, not long enough to study long-term results. Patients often dropped out of drug studies due to side effects. Drug studies tended to involve sicker patients and measured how symptoms improved. Psychotherapy studies tended to enroll healthier patients and report how they felt. There were few psychotherapy studies, many drug studies.
"Psychotherapy is swimming upstream against a lot of self-serving (drug) industry studies." Psychotherapy also is losing market share due to managed care restrictions, Crits-Cristoph said.