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One of the biggest reasons that antidepressant meds are the go-to treatment for depression in the US is reimbursement. This reason is a cause of another importa
by aaavl2821 9y ago
One of the biggest reasons that antidepressant meds are the go-to treatment for depression in the US is reimbursement. This reason is a cause of another important problem with mental healthcare in the US: shortage of mental health providers
Reimbursement for psychotherapy has been getting squeezed in the last several years. Reimbursement for psychotherapy is generally based on time: i.e. $x for a 30 minute session, $y for a 90, etc. Reimbursement for "medication management", i.e. prescribing drugs, is not based on time, but generally is a fixed amount. So the more prescriptions you write, the more money you make. Psychiatrists therefore focus on meds rather than therapy, as the reimbursement rates for therapy can't support a practice. Many psychiatrists don't take insurance at all bc they don't want to be "medication mills", so they charge $200-600+ per hour for therapy and only rich clients can pay. Psychologists and other licensed therapists can't prescribe meds, so they do therapy, but often make less than $60-70k a year. People don't want to go into psychology / psychiatry because of the stress of dealing with suffering people without having the tools to help them, and then getting paid relatively little (compared to other health care professionals)
This results in much of depression and other mental health being treated in primary care. PCPs aren't trained that well in treating mental health beyond what pharma sales reps tell them, so they wrote an rx and call it a day. 70% of patients don't respond to the first trial of antidepressants, but PCPs don't really know how to handle this
- gcb0 9y agothank you for finally making clear the evil incentives behind US psychiatrist being less than drug peddlers. always wondered how the drug industry managed to coerce a whole professional group into being so malignous to society.
- refurb 9y agoDoctors don't make any money from writing a script (beyond the payment for the consultation). In fact, the would make more money if they used counseling rather an a drug.
- nasredin 9y agoIIRC there is an issue here. Former doctors who now work for pharma companies and take their peers to dinners and push the new (patented) drugs. Doctors then prescribe these new drugs perhaps needlessly (Vioxx?) or over generic ones. Also in my experience counseling is only affordable to the wealthy or people in the criminal justice system (where it is already too late IMHO).
- matt4077 9y agoYou make a completely benign mechanism sound like a vast conspiracy... The simple fact, which you already mentioned, is that psychotherapy takes dozens of sessions with an expert to be effective. Cost of treatment is in the four digits, easily, while medication costs less than $10/week since most SSRIs are no longer protected by patents. Psychotherapy and medication have almost identical effectiveness, making the latter the preferable first-line option in almost all cases.
- aaavl2821 9y agoIt may be rational for payers to minimize cost of care rather than try to find a better balance between cost of care and outcomes, but that doesn't make it benign. The preferable first line option would be medication + psychotherapy, or at least medication and regular follow up to ensure it's working and adjust dose if needed 6-12 sessions of CBT (NICE recommends 6-8 for mild to moderate depression) with a licensed clinical social worker would be comparable in cost to a year of generic SSRIs. However 55% of US counties don't even have a mental health professional (because payers stopped paying for it), so CBT isn't really an option for many