Medication and psychotherapy: usage and effectiveness in treating mental illness
This article is part of a broader effort to research the mental health crisis in the U.S.
Here's what we know so far:
In 2020, out of 52.9 million U.S. adults with a mental illness, only 46.2 percent received mental health services or took prescription medication.
So more than half of U.S. adults with a mental illness did not receive services or medication.
These are the top three reasons for not receiving treatment:
Could not afford the cost of care
Not knowing where to go for services
Believing they could handle the problem without treatment
And things got worse during the pandemic.
Methodology
It's clear that there's a problem: half of people with a mental illness are not receiving treatment.
Our goal is to make sure that everyone with a mental illness who wants to get treatment is able to.
To achieve this, we need to solve the reasons why people say they're not getting treatment.
But first, it's important that we understand the existing options for treatment.
Because it's possible there are inherencies of the existing treatment options that are to blame for the reasons people are not receiving treatment. If so, we may have to consider different treatment options that do not have the same inherencies.
Also, we want to look at the effectiveness of existing treatment options. If they're not effective, then it doesn't matter how many people are receiving them and we may have to consider different treatment options that are more effective.
On the other hand, if the existing treatment options do not have any such inherencies and are effective, then the solution is simple: solve for the reasons why certain people are not receiving treatment in order for those people to receive treatment.
Medication and psychotherapy are the most common treatments for mental illness
According to Michael B. First, Professor of Clinical Psychiatry at Columbia University:
"Most treatment methods for mental health disorders can be categorized as either
Somatic
Psychotherapeutic
Somatic treatments include drugs, electroconvulsive therapy, and other therapies that stimulate the brain (such as transcranial magnetic stimulation and vagus nerve stimulation).
Psychotherapeutic treatments include psychotherapy (individual, group, or family and marital), behavior therapy techniques (such as relaxation training or exposure therapy), and hypnotherapy."
In October 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a report, which included data on the type of mental health services received by U.S. adults.
"In 2020, 16.9 percent of adults aged 18 or older (or 41.4 million people) received inpatient or outpatient mental health services or took prescription medication in the past year for a mental health issue."
13.8 percent took prescription medication.
8.8 percent received outpatient services.
0.9 percent received inpatient services.
Medication and psychotherapy are both effective
Medications are effective in treating mental health disorders.
Placebo-controlled trials have shown that antidepressants can relieve symptoms of depression. And there are various medications that are effective in treating anxiety.
Here is an extensive list of mental health medications published by the National Alliance on Mental Illness. And here is another resource for mental health medications published by the National Institute on Mental Health.
Psychotherapy is also effective in treating mental health disorders.
In August 2012, after an extensive review of psychotherapy research studies, the American Psychological Association (APA) approved a resolution on psychotherapy effectiveness.
"The resolution cites more than 50 peer-reviewed studies on psychotherapy and its effectiveness in treating a spectrum of health issues and with a variety of populations, including children, members of minority groups and the elderly."
There is evidence to suggest that both medication and psychotherapy are effective in treating mental illness.
Of course, it depends on the specific mental illness. Different treatments are recommended for different illnesses.
Using medication and psychotherapy together is the most effective
Dr. Michael B. First, Professor of Clinical Psychiatry at Columbia University, writes,
"Most studies suggest that for major mental health disorders, a treatment approach involving both drugs and psychotherapy is more effective than either treatment method used alone."
The APA has reached a similar conclusion:
"Research shows that a combination of medication and psychotherapy is often most effective in treating depression and anxiety."
There are several reasons to prefer psychotherapy over medication
There are several reasons to prefer psychotherapy over medication, according to the evidence included in the APA's Resolution on the Recognition of Psychotherapy Effectiveness (approved in August 2012).
Psychotherapy teaches patients skills that are used even after the treatment ends, so the results of psychotherapy last longer.
"The results of psychotherapy tend to last longer and be less likely to require additional treatment courses than psychopharmacological treatments. For example, in the treatment of depression and anxiety disorders, psychotherapy clients/patients acquire a variety of skills that are used after the treatment termination and generally may continue to improve after the termination of treatment (Hollon, Stewart, & Strunk, 2006; Shedler, 2010)."
Psychotherapy is as effective or more effective than pharmacological treatments. Also, pharmacological treatments have adverse side effects.
"The effects produced by psychotherapy, including the effects for different age groups (i.e. children, adults, and older adults) and for many mental disorders, exceed or are comparable to the size of effects produced by many pharmacological treatments and procedures for the same condition, and some of the medical treatments and procedures have many adverse side-effects and are relatively expensive vis-a-vis the cost of psychotherapy (Barlow, 2004; Barlow, Gorman, Shear, & Woods, 2000; Hollon, Stewart, & Strunk, 2006; Imel, McKay, Malterer, & Wampold, 2008; Mitte, 2005; Mitte, Noack, Steil, & Hautzinger, 2005; Robinson, Berman, & Neimeyer, 1990; Rosenthal, 1990; Walkup, et al., 2008; Wampold, 2007, 2010)."
Many people prefer psychotherapy to pharmacological treatments. Related to this, psychotherapy is more cost-effective than pharmacological treatments in the long term.
"Many people prefer psychotherapy to pharmacological treatments because of medication side-effects and individual differences and people tend to be more adherent if the treatment modality is preferred (Deacon & Abramowitz, 2005; Paris, 2008; Patterson, 2008; Solomon et al., 2008; Vocks et al., 2010). Research suggests that there are very high economic costs associated with high rates of antidepressant termination and non-adherence (Tournier, et al., 2009), and psychotherapy is likely to be a more cost effective intervention in the long term (Cuijpers, et al., 2010; Hollon, et al., 2005; Pyne, et al., 2005)."
Sources for the citations in this section can be found here.
Medication is more commonly used than psychotherapy
Despite the reasons to prefer psychotherapy over medication, medication is more commonly used than psychotherapy in treating mental illness.
Above, in Figure 49 from the SAMHSA report, you see that, over the past almost two decades, medication has consistently been more frequently administered than inpatient and outpatient mental health services combined.
According to government and insurance industry data in 2012,
"The use of psychotherapy to treat people with mental and behavioral health issues decreased over the last decade while the use of medications to address such problems has increased.”
At the time, Melba J. T. Vasquez, past president of the APA, blamed ads as the reason why more consumers were opting for drugs instead of psychotherapy:
“Every day, consumers are bombarded with ads that tout drugs as the answer to their problems. Our goal is to help consumers weigh those messages with research-based information about how psychotherapy can provide them with safe, effective and long-lasting improvements in their mental and physical health."
Conclusion
Medication and psychotherapy are the most common treatments given to U.S. adults with a mental illness.
While both treatments are effective on their own, the most effective treatment is medication and psychotherapy together.
When used on their own, psychotherapy is preferred over medication for several reasons. Despite this, medication is still more commonly used than psychotherapy.
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