Friday, July 20, 2007

Backlash against antidepressants is fueling new interest in alternative treatments.

From the Wall Street Journal (With a tip of the hat to Furious Seasons) here are some of our favorite snippets from a much larger article

From lobotomies with ice picks to early antidepressants that caused brain hemorrhaging, Americans have a complicated and ever-changing approach to treating mental illness. Now, spurred by the growing disenchantment with antidepressants, an increasing number of people are seeking treatment for depression, anxiety and eating disorders from naturopaths, acupuncturists and even chiropractors. At the same time, more traditional psychiatrists are incorporating massage and meditation in their practices.

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A backlash against antidepressants sparked by concerns about their safety, efficacy and side effects is helping drive patients to alternative methods. Some 80% of antidepressants are currently prescribed by primary doctors who often diagnose depression in a 20-minute visit and don't provide accompanying therapy or help manage side effects.

Sales of all classes of antidepressants were $13.5 billion in 2006, down from a peak of $13.8 billion in 2004, according to IMS Health, a health-care information company. Usage of selective serotonin-reuptake inhibitors (SSRIs) dropped in 2005 after warnings about side effects -- particularly the risk of suicidal behavior in people aged 25 and under, which prompted the Food and Drug Administration to order drug makers to add warnings to their packaging in 2004. The introduction of generics onto the market (most recently, for Zoloft) also contributed to lower sales.

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At the same time, the rise of managed care and changes in Medicaid and Medicare have resulted in companies paying far less for mental health coverage. Employer spending on mental health care dropped to 1.3% of an employee's medical care costs in 2006, from 10.9% in 1988, according to employee-benefits firm Towers Perrin. While most employees with health insurance have some mental-health coverage, only 13% have coverage for an unlimited number of outpatient visits to providers such as psychiatrists, psychologists and social workers, says a 2006 survey of employers by the Kaiser Family Foundation. That's down from 19% in 2004. Most insurance policies pay for a limited number of visits, often 20 or 30 per year, and some put a cap on the dollars they'll pay.

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Proponents of alternative medicine say the wide range of treatments used address broader causes like hormonal imbalances and stress. Treatment can mean spending time talking to patients about their physical and emotional problems, examining their diet and exercise habits, and doing blood tests to look for medical or environmental causes for depression, such as Lyme disease, toxic chemicals or mold.

In Los Angeles, naturopath Holly Lucille has seen 30% more patients in the past two years whose chief complaint is mental-health-related, while Sara Thyr, a naturopath in Manchester and Concord, N.H., has seen a 20% rise. Margot Longenecker's naturopathy practice in Branford and Wallingford, Conn., now has half of its patients come for anxiety and depression, compared with 25% three years ago.

"Half the time you feel like you have a psychiatric degree more than a chiropractic degree," says Basking Ridge, N.J., chiropractor Jerry Szych, who's seen a 25% rise in patients seeking counseling services over the same period. Columbus, Ohio, chiropractor Ronald Farabaugh says he has seen an increase of 20% over the past three years in those cases.

Melissa Mannon, a 36-year-old photographer in Bedford, N.H., saw psychologists for years about her depression and anxiety. Then she visited a naturopath for help with infertility, and was diagnosed with an intolerance to 90 different foods, including gluten. She changed her diet and within seven months, she got pregnant and most of her anxiety and depression went away, she says. She still sees her naturopath if she's feeling down and to discuss what's happening in her life. "She understands me," says Ms. Mannon.

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Of course, alternative medicine has been used for mental health issues for years. A 2001 study by Ron Kessler and David Eisenberg at Harvard Medical School found that among those with anxiety and or depression, more than half used alternative medicine therapies; among those who sought the treatment of a licensed conventional provider, two-thirds also used alternative medicine during the prior year. The perceived helpfulness of the alternative therapies was similar to the perceived helpfulness of conventional therapies.

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