Medical Cost-Savings from Counseling

Medical insurance is increasingly being priced out of what many feel they can afford. It can be argued that ever increasing health insurance costs have largely decimated the US car manufacturers.

What if there was a way to save 20% of medical costs? What if I told you that is such a way? It has been reported that when numerous rigorous studies were examined on medical cost savings after psychotherapy, that the average savings was about 20%! Some studies have shown higher.

Many will be surprised to learn that psychologist Nicholas Cummings, PhD first wrote about this in 1962! One of the first studies to look at these issues was conducted in the 1960s at Kaiser. Records were followed over a 5 year span for 152 patients who had received psychotherapy. Of those, 80 were seen for only one session. A control group (No therapy) was matched for age. Over the five years, the medical utilization of the control group increased. Utilization decreased for those who had received therapy. Hospitalization rates fell from 5 days/year prior to the study to .7 days/year.

Studies range from studying groups with no common diagnoses to groups of distinct diagnoses. While some studies looked at single issues, such as depression, panic attacks, etc, many of the studies looked at people with all kinds of medical problems, such as hypertension, other cardiac difficulties, chronic pain, cancer, etc. In addition to looking at those who received individual therapy, other studies looked at marital therapy as an adjunct to alcohol treatment, brief intensive in-home family therapy for children and adolescents with severe behavioral issues, and group therapy.

Another review of studies showed that 85% of 58 studies showed a decrease in medical utilization after psychotherapy.

There is momentum where health care reform will soon be attempted. It is past time for the public to learn that psychological interventions often decrease and sometimes eliminate the need for medical interventions. There needs to be a greater education of this information.

If you are interested in learning more about these issues, an excellent read is The Impact of Medical Cost Offset on Practice and Research: Making It Work for You (2002) edited by Nicholas Cummings, et. al.

Best wishes,
Mike

Are All Anti-depressants created equally?

Historically, it has been reported that the overall effectiveness of the newer and older anti-depressants were all about equally effective, differing in their side effects. A very recent article in The Lancet disputes this, comparing the effectiveness of 12 of the newer anti-depressants for Major Depression in adults. It looked at side effects, as well.

A summary of their findings found the following to be more effective:

Remeron
Lexapro
Effexor
Zoloft

They also reported the following to be less effective:

Cymbalta
Prozac
Luvox
Paxil
Edronax (least efficacious)

Lexapro and Zoloft were found to have significantly fewer discontinuations due to side effects.

This does NOT mean that if you are taking one of medications found to be "less effective" and it is working, that you should change. Nor does it mean if you are taking one of the "more effective" medications and are having difficult side effects, that you need to continue that medication.

Any medication is the Best medication for one person and the Worst for another. It is imperative that you consult and work closely with your prescribing physician.

An earlier post of mine Drugs vs. Therapy (9/5/08) compared the effectiveness of each. Here is a summary:

Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.

Best wishes,
Mike

For a Summary of the article: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60046-5/fulltext

Drugs vs. Therapy

As I touched on in my previous posting about depression, there are interesting studies comparing the treatments of medications and psychotherapy/counseling. One sees medication ads almost any tie you turn on the TV, look in a magazine, etc. Research proves that the advertising works. Increasing numbers of people are taking medications for depression, stress, etc. The number of people seeking counseling may be decreasing.

Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.

There is some evidence that therapy may be the better choice for those experiencing panic attacks. One study "found higher treatment effect sizes, lower attrition rates, and favorable cost profiles for talk therapy as compared to medication treatment for this disorder." There are fewer studies for panic than for depression. Therefore, one should be slower to declare a conclusion.

It may be surprising (including to many mental health professionals) that therapy can also be very helpful in the treatment of schizophrenia. An examination of many studies (a meta-analysis) "found that people treated with talk therapy in addition to medication were significantly better off than those treated with medication alone."

There are several other interesting findings from the huge muti-site research on depression. More effective therapists focus less on medications. Also, that the relationship with the psychiatrist is predictive of how helpful medication will be. There was a parallel with some behavior therapists, years ago. The parallel is that the medication or behavioral treatment are what is important and that the relationship is not. Behavior therapists have come to understand this. Some psychiatrists still have this lesson to be learned.

What can one conclude? First, that treatment works for most people. Second, the relationship with any mental health (and probably non mental health) providers is critical. Third, that the drug companies have great influence on what treatments people seek. This posting is not intended as anti-medication. I have encouraged numerous individuals to try medications for a variety of conditions. Rather, medications are not the only choice and sometimes the lesser choice. Lastly, if you are unhappy with your provider, try to make your complaints known to that person.

Best wishes,
Mike

For full report: http://www.talkingcure.com/archives.asp?id=129&fragment=0&SearchType=AND&terms=depression+relapse

Depression Patients’ Brain Circuitry Makes Them Vulnerable to Relapse

"Using brain imaging, NIMH researchers have produced direct evidence that people prone to depression -- even when they're feeling well -- have abnormal mood-regulating brain circuitry. This makes them vulnerable to relapse when levels of certain key brain chemical messengers plummet.

To test this directly and identify any brain circuit abnormalities, the researchers studied 15 un-medicated subjects in remission who had a history of depression by giving them a drug that temporarily depleted their brains of dopamine and norepinephrine.

These subjects experienced an increase in depression symptoms and a decrease in the ability to feel pleasure. PET scans showed that this was accompanied by an increase in activity in a depression-implicated brain circuit. By contrast, activity decreased or remained unchanged in the same brain circuit with depletion in 13 healthy participants who experienced only minor mood effects. Activity in specific brain structures in the circuit corresponded with a set of mood effects (see graphics below)."

This offers some evidence of why there is such a high relapse rate in depressed individuals. However, there are many studies that show while therapy and medications are about equally effective treatments, that there is a high relapse for those receiving meds only, if they discontinue the meds. Those receiving therapy, have a much lower relapse rate.

This is further evidence that depression is a bio-psycho-social disorder (generally has biological, psychological, and social factors) and that effective psychological interventions ALSO positively effect one's biology. The reality is that the psyche affects the soma, the psychological effects the biological, or the mental effects the physical. In other words, there is an endless loop where both effect the other.

Best wishes,
Mike

For full report: http://nimh.nih.gov/science-news/2008/depression-patients-brain-circuitry-makes-them-vulnerable-to-relapse.shtml