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Drug vs. Talk Therapy for Depression

Survey Shows Antidepressants' Side Effects More Common Than Package Labels Indicate

Drug Therapy vs. Talk Therapy

Researchers based the report on surveys completed by more than 3,000 Consumer Reports readers, and is published in the magazine's October issue.

Specifically, it shows that:

  • A combination of talk therapy and drugs worked best for treatment of depression and anxiety. But those whose treatment consisted of mostly talk therapy did almost as well if they had 13 or more visits with the therapist.
  • Treatment consisting of mostly drug treatment was also effective for many people. Drugs had a quicker impact on symptoms than talk therapy, but it often took trial and error to find a drug that worked without undesirable side effects.
  • More than 50% of survey respondents who took antidepressants tried two or more drugs; 10% tried five or more. "It really does have to be a process of trial and error... because there's no predicting people's response to [antidepressants]," says Nancy Metcalf, a Consumer Reports senior editor and author of the survey.
  • Side effects were much more common than noted on the medications' package information: 40% said they experienced a loss of sexual interest or performance, and almost 20% said they gained weight. Why the discrepancy? In clinical trials, people are not asked specifically about certain side effects, Metcalf tells WebMD. "They were expected to volunteer the information, and they may not be as willing to do that."
  • Treatment from primary care doctors was effective for people with mild problems, but less so for people with more severe ones. Treatment by mental health specialists yielded significantly better results for people who started out in poor shape.
  • Health insurance plan limits on therapy visits and costs kept some people from getting the best treatment.
  • Consumers who did their own research and monitored their own care reported better results.
  • More than 80% of survey respondents said they found treatment that helped.

Another finding: Nearly one in five people said their health plans don't cover mental health. "That's an odd statistic to us, because we know that almost all employer-provided health care plans have mental health coverage," says Metcalf. "Either people were too shy to seek reimbursement or were having trouble accessing it."

Many Routes to Good Care

"What comes through overall -- there are many routes to good care, but it takes flexibility and persistence to get there," says Metcalf. "The more committed to your own care, the better off you'll be -- whether that means finding a different therapist, cutting through red tape with your mental health coverage, or applying what you learn in therapy to your life."

"Some companies do what's called a 'carve-out' mental health coverage, which means they contract it other to another company," she tells WebMD. "If you call the 800 number on your health plan card, you may get someone who doesn't know very much about your mental health coverage. That's where persistence pays off. You really need not give up until you find someone who knows about your health plan. Mental health coverage is often very different from health coverage."

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