According to a new survey from Consumer Reports patients in talk therapy did just as well as those only taking medication, and respondents were equally satisfied with psychologists, social workers or licensed therapists, yet nearly 80 percent of people seeking treatment for depression or anxiety were prescribed antidepressants, indicative of the growth in the use of these drugs. The report, based on subscriber responses, also finds that anxiety is on the rise. Of the 1,500 subscribers seeking treatment, 58 percent had experienced anxiety, up from 41 percent in 2004 when CR last surveyed subscribers about these conditions. The 2009 survey provides a window into how mental health treatment is practiced in the real world, plus ratings of drugs readers found effective. The survey found that older, often less expensive antidepressants known as SSRIs (selective serotonin reuptake inhibitors) like Lexapro, Celexa, Prozac and Zoloft work just as well, and with fewer side effects, than newer, more costly drugs known as SNRIs (serotonin and norepinephrin reuptake inhibitors) like Cymbalta and Effexor. SSRIs and SNRIs address depression by altering the levels of certain brain chemicals. When asked to rate antidepressants, 53 percent of respondents taking SSRIs said they helped “a lot.” SNRIs fared no better, with only 49 percent of respondents reporting they helped “a lot.” When it comes to side effects, SSRIs performed better than SNRIs with 31 percent of respondents reporting sexual side effects, 16 percent reporting weight gain, and 12 percent reporting sleep problems. Of those taking SNRIs, 36 percent reported sexual side effects, 22 percent reported weight gain, and 16 percent reported sleep problems. Bupropion, which is neither an SSRI nor an SNRI, helped 48 percent of respondents “a lot.” In terms of sexual side effects and weight gain, it was tolerated better than the SSRIs and SNRIs.
Drugmakers spent almost $300 million in 2009 on ads for two newer antidepressants: duloxetine (Cymbalta) and desvenlafaxine (Pristiq). “Pharmaceutical companies stand to profit most from convincing consumers that drugs are the only answer to depression and anxiety, and that newer, more expensive drugs are a better alternative to older drugs and their generic counterparts,” said Nancy Metcalf, senior program editor, Consumer Reports Health. “Our survey shows that a combination of therapy and medication works best, and that despite the intense marketing push consumers are subjected to, there is no evidence that newer drugs like Pristiq and Cymbalta work any better than older medications in their class.”
Talk therapy offers two advantages over medication: no drug side effects and tools you can use for the long term. It received high marks from CR’s survey participants—91 percent said therapy made things “a lot” or “somewhat” better. People who stuck with talk therapy for at least seven sessions had significantly better outcomes that those who went to six or fewer sessions. What’s more, they scored as high as people treated mostly with medication on an overall outcome scale. And the type of therapist was less important: those who saw psychologists (PhDs), social workers (MSWs), or licensed professional counselors (LPCs) all reported equal levels of satisfaction. The report is available in the July issue of Consumer Reports and online at http://www.ConsumerReports.org.
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