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Drug Therapy or Talk Therapy?
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Drug therapy has become a more prevalent mode of treatment for emotional problems in the last decade. When we surveyed our readers in 1994, only 40 percent of those who sought care for any type of mental-health problem received drugs compared with 68 percent in the current survey (and 80 percent of those with depression or anxiety)--a number that reflects the fast-growing sales of antidepressant drugs over the past decade. Managing depression for Claudia Meadows, 55 of Shoreline, Wash. managing her chronic major depression is “a full-time job.” Because her husband's job provides membership in Seattle's Group Health Cooperative HMO, she has care from a well-coordinated team. “I can get useful therapy, face-to-face psychiatric appointments when I need them, medications at the walk-in pharmacy or by mail, online help, telephone nurse consultations, and my doctor returns phone calls within hours.” With this support, Meadows has raised two sons, works part-time as a bus driver, and is developing a photo greeting card business. Still, someone entering treatment today has the same basic choices they would have had a decade ago: talk therapy, drug therapy, or a combination. While our results suggest that all of these options can work for many cases of anxiety and depression, the combination of talk and drugs was the overall winner. The reason could be that drug and talk therapies work at very different paces. Respondents who took drugs improved substantially within a few visits. Within six visits, those whose treatment consisted of mostly medication had improved as much as those who had 13 or more visits. By contrast, respondents who elected mainly talk therapy improved more gradually. If they had just six visits or fewer, they fared worse than patients on medication. But if they stuck with their therapy for 13 or more visits, their outcome was better than those who relied mainly on medication. The most successful patients of all were those who received a balance of drug and talk therapies. They had the advantage of quick improvement with the drugs, followed by steady continuing improvement from the talk. The number of talk therapy sessions received by people with a mental problem drastically declined over the last decade. In 1994, survey respondents averaged well over 20 visits with a mental-health professional, while in the current survey the average was 10 visits. Since our survey indicates that longer-term therapy is linked to more positive outcomes, that trend is troubling. Striking the right balance between medications and “enough” talk therapy sessions can be tricky. Asking hard questions of the professional recommending treatment can help people understand their options. These questions should include: What's your understanding of this problem? What kind of treatments would you recommend and why? How long will it take to experience some relief of symptoms? How long will I need to stay on medication and/or continue with talk therapy to get the maximum benefit?

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