Posted on: Wednesday, October 13, 2004

Meds and talk may be best anxiety cure

By January W. Payne
Washington Post

A survey of more than 3,000 patients with symptoms of depression and anxiety found that those who combined drugs and talk therapy tended to fare better overall than those who opted for "mostly drug" or "mostly talk" therapy.

While the analysis, published in the October issue of Consumer Reports magazine, is based on readers' self-reports — and therefore is not of the "gold standard" quality the medical community prefers to use as a basis for treatment decisions — a range of experts said the carefully done survey provides a useful view of treatment outcomes with typical patients.

Patients who had combination therapy and attended 13 or more talk therapy sessions had the highest "outcome score" — 80 — on the 100-point scale researchers used to measure respondents' satisfaction with their treatments and improvement in their conditions. The lowest score, a 70, was for those who had "mostly talk" therapy and attended one to six sessions.

Other recently published studies had similar findings. A National Institutes of Health clinical trial of more than 400 adolescents with major depression found that combining drugs and psychotherapy was the most effective treatment.

The findings, published in August in the Journal of the American Medical Association, compared cognitive-behavioral talk therapy with use of the antidepressant fluoxetine (Prozac).

Consumer Reports found that while drugs relieved symptoms of depression and anxiety faster, talk therapy was as effective as drugs when patients continued therapy for at least 13 sessions. The data also found greater incidence of side effects from medication than are cited in company-funded studies and on product labels.

"One of our big findings was that talk therapy rivaled drug therapy in effectiveness," said Donato Vaccaro, a research program leader for Consumer Reports. "People who told us that their therapy was mostly talk therapy, and it lasted for 13 sessions, had better outcomes than those whose therapy was described as mostly medication."

More than 80 percent of survey respondents reported having found a treatment that worked. The authors said people for whom treatment failed were probably less likely than others to take the 38-question survey.

The survey marks the second time Consumers Union — an independent research and publishing group that evaluates products and services ranging from automobiles to heart-rate monitors and accepts no advertising or corporate grants — has measured patients' mental healthcare experiences. It found that many more people seeking help for mental health problems are taking drugs now than were in 1995, when the previous survey results were published.

"The biggest change that we've noticed is that there has been a dramatic shift from talk therapy to drug therapy," Vaccaro said. In 1995, 40 percent of respondents reported taking medications to treat their conditions, compared with 68 percent in this survey.

About 18.8 million U.S. adults experience depression every year, according to the National Institute of Mental Health. The three most common types are major depression (a combination of symptoms, including feelings of pessimism, hopelessness and guilt, that can disrupt daily routines and personal relationships), dysthymia (less debilitating but featuring long-term, chronic symptoms that make life less enjoyable) and bipolar disorder (mood changes from extreme highs to severe lows, also called manic-depressive illness).

Anxiety disorders — which include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder and phobias — affect an estimated 19 million adults each year.

More than 4,000 people responded to this year's survey. Consumer Reports based its report on the 3,079 respondents who described themselves as depressed (40 percent), anxious (17 percent) or both (43 percent). The excluded respondents had sought help for other mental health issues such as eating disorders, marriage problems and grief counseling.