A line was crossed in 2005 as anti-depressant medication became the most widely prescribed class of drug in the USA. Here in England, the use of anti-depressants has risen to its highest ever level with 50 million prescriptions written last year. And yet a new meta-analysis finds that, given the choice, the vast majority of patients would prefer to receive psychotherapy over drugs.
“It is unclear why the shift toward pharmacologic and away from psychological treatment is occurring,” the researchers said, “although limited access to evidence-based psychological treatments certainly plays some role.”
Kathryn McHugh and her colleagues identified 34 relevant peer-reviewed studies up to August 2011 involving 90,483 people, in which the participants were asked to indicate a straight preference between psychotherapy or drugs. Half the studies involved patients awaiting treatment, the others involved participants who were asked to indicate their preference if they were diagnosed with a psychiatric disorder. The researchers had hoped to study preferences among patients with a diverse range of diagnoses but they were restricted by the available literature – 65 per cent studies pertained to depression with the remainder mostly involving anxiety disorders.
Overall, 75 per cent of participants stated a preference for psychotherapy over drugs. Stated differently, participants were three times as likely to state that they preferred psychological treatment rather than medication. The preference for therapy remained but was slightly lower (69 per cent) when focusing just on treatment-seeking patients, and when focusing only on studies that looked at depression (70 per cent). Desire for psychotherapy was stronger in studies that involved more women or younger participants.
Given the evidence showing comparable efficacy for psychotherapy and medication in treating most forms of anxiety and depression, the researchers said their data “support empirically based practice decisions in favour of greater rates of selection of psychological treatment for these disorders.”
This new study provides further justification for the UK’s Improving Access to Psychological Therapies (IAPT) programme that started a nationwide roll-out in 2008. However, if most people prefer therapy but drug prescriptions are still rising, this raises the question of how effective the IAPT project has been. Coincidentally another recent paper concluded that that IAPT has failed to curb the long-term rise in antidepressant prescriptions in England.
Unfortunately, the current research by McHugh et al has several problems that limit its impact. This includes the fact it was unable to look in detail at preferences for combination therapy (drugs plus psychotherapy), nor factors such as illness severity or urgency. Above all, the nature of the study means it can’t tell us anything about why most people prefer psychotherapy over drugs, although likely explanations include fear of health risks and stigma.
McHugh RK, Whitton SW, Peckham AD, Welge JA, and Otto MW (2013). Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. The Journal of Clinical Psychiatry, 74 (6), 595-602 PMID: 23842011