Add one more piece of data to the on-going debate about the efficacy of pharmaceutical medication versus therapy to treat mental illness.
In a decision about the best form of treatment, patient compliance should play a role, according to Roger Greenberg, Ph.D, distinguished professor and head of the psychology division at SUNY Upstate Medical University.
A major roadblock to the effectiveness of any treatment is the participant’s willingness to engage in and to comply with the full course of treatment. And, according to a review of research done by Greenberg and published by the American Psychological Association’s journal Psychotherapy in March, people are more likely to agree to be treated with psychotherapy and more likely to stick with it.
Greenberg joined forces with Joshua Swift, Ph.D., of Idaho State University to run a meta-analysis of 186 studies where patients were assigned to either psychotropic drugs or talk therapy (or a combination of the two).
“We found that, if a patient agreed to participate, the dropout rate for psychotropic drugs was far higher.” said Greenberg.
The research showed that patients offered drugs alone refused treatment 1.76 times more often. Once treatment had begun, the premature termination rate was 21.9 percent on average for all treatments but patients on drug-only regimens were 1.2 times more likely to drop out.
What he found interesting within the various studies, Greenberg added, was that these patients were asked if they would participate and then randomly assigned medication or therapy. Even though they had signed on, he said, a large number of those who were assigned to medication-only refused the treatment outright.
“Twice as many people said no right up front when they were assigned to the drug-only therapy,” he said. “They were hoping to be assigned to the psychotherapy side.”
Further dissecting the data, the researchers found that preferences between therapy and medication were even more markedly different between disorders. For example, participants diagnosed with depressive disorders had a refusal rate for pharmacotherapy that was 2.16 times higher and those with panic disorders refused medicine-only treatments nearly three times as often.
Although the trend in the U.S. is towards a rising use of pharmacotherapy, Greenberg found that the reputation of psychoactive drugs has far outpaced the empirical data supporting its efficacy.
“This is in contrast to what is being told to the country as a whole,” Greenberg said, “that drugs are the answer to mental health problems.”
The increase in mental health drug prescriptions since the early 1980s, he added, could be blamed on the introduction of SSRIs, which many thought to be a wonder drug, along with the changing of regulations that now allows pharmaceutical companies to advertise directly to consumers.
“Only one other country in the world allows that, New Zealand,” he said. “Today about one-fourth of women and 15 percent of men in the U.S. take antidepressants.”
While his work may seem to be an indictment of drug therapy, it is not, Greenberg said. Instead, he hopes that the mental health world will see these findings instead as a validation of the need for human connection in treatment.
“It turns out that the interpersonal situation you set up with the patient is the most important factor,” he said. “This might seem logical with therapy but it holds true when getting medicine. It is important to maintain a relationship between the doctor and the patient, more than a quick checkup.”
It is also important, he added, to be clear with clientele when setting up treatment. Get their input and understand their preferences in order to ensure compliance, he said.
By Catherine Robertson Souter