Psychiatrists as Therapists: A Vanishing Breed

In an article in the New York Times on Sunday, writer Gardiner Harris described how many psychiatrists have abandoned psychotherapy in favor of short consultations and pharmacotherapy; if patients want to discuss their problems, they are referred to a therapist. The main driver of this trend is money—with other, cheaper professionals available to provide therapy with comparable results, insurance companies won’t pay the higher fees most psychiatrists charge. So, instead of seeing 50 to 60 patients a week for the traditional 45-minute session on the psychiatrist’s couch, the psychiatrist can see 1,000 or more patients in a 15-minute, “what’s happening? do you need a medication adjustment? see you next week” check-up. As the wife and business manager of the psychiatrist profiled in the article says, “It’s all about volume.” One only hopes that most of the patients take his advice to see a therapist.

In fact, there is a growing body of evidence favoring psychotherapy over medications in mental health, notably in depression. In a recent meta-analysis in the Journal of Nervous and Mental Disease comparing psychotherapy with second-generation antidepressants (SGAs), researchers found that “

[b]ona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.” 

And in the March issue of AJN, we report on a study published in the Archives of General Psychiatry, which found that “cognitive therapy combined with daily practice of meditation, yoga, and other health-enhancing behaviors can be as effective as long-term antidepressant medication alone in preventing relapse in patients who have had several bouts of major depression.” 

It’s a shame that so many psychiatrists are abandoning an effective treatment method for financial reasons. According to the National Institute of Mental Health, in a given year over 26% of Americans over age 18 suffer from a mental disorder, and “major depressive disorder is the leading cause of disability in the U.S. for ages 15–44.” With these numbers, we need all hands on deck.