Drug vs. Talk Therapy for Depression
Survey Shows Antidepressants' Side Effects More Common Than Package Labels Indicate
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."
Important note: Under the American Disabilities Act, an employer cannot discriminate against an employee getting mental health care, Metcalf adds. "There are also restrictions as far as how much information your therapist can turn over. Your health care plan knows about drugs you are taking, and very generally about your condition. But they do not have access to personal notes made by your doctor -- the most private information. That is legally protected."
Also encouraging is "there has been a lot of effort in the last five or 10 years to bring primary care doctors up to speed about depression, and either treat [patients] or refer them to a mental health professional," Metcalf says. "The most important point is to get help somewhere ... and get it promptly."
Many types of mental health professionals can provide excellent therapy, she notes. The survey showed that whether they saw a psychiatrist, a psychologist, or a social worker, patients had equally good results. How to choose your therapist? "It's largely personal preference," Metcalf tells WebMD. "Just keep in mind, if you go to see a psychiatrist, you are much more likely to get medication. Psychologists and social workers provide talk therapy ... and they can be more cost-effective if you pay out of pocket, which many of our respondents did."
"Many insurers refuse to allow psychiatrists to do anything but prescribe drugs, except for the most severely ill patients," notes Bruce Schwartz, MD, in the report. He is associate professor of clinical psychiatry at Albert Einstein College of Medicine in New York City and one of two consultants who helped design the survey and interpret the results.