Comparing 1998 with 2007, the percentage of those receiving psychotherapy fell from 53.6% to 43.1%, a downward trend that continued from the decade prior, Mark Olfson, MD, MPH, of Columbia University, and colleagues reported in the Archives of General Psychiatry.
For some patients, "depression care may be becoming more narrowly focused on pharmacotherapy," they wrote.
Due to the growth of selective serotonin reuptake inhibitors (SSRIs) and newer medications, the rate of outpatient depression treatment increased markedly in the U.S. between 1987 and 1997. But it was not known whether the trend has continued, the researchers said.
So they looked at data from the Medical Expenditure Panel Surveys from 1998 and 2007.
They found that those earlier rapid increases in depression treatment were followed by more modest increases: the rate of outpatient treatment for depression increased from 2.37 per 100 persons in 1998 to 2.88 per 100 in 2007 (OR 1.18, 95% CI 1.03 to 1.35).
That corresponds to an increase from about 6.5 million to 8.7 million patients, they said.
Treatment with antidepressants remained about the same, rising only slightly from 73.8% in 1998 to 75.3% in 2007, and the researchers said this trend was significant for those ages 50 to 64 and for uninsured patients.
Yet the percentage of those receiving psychotherapy fell from 53.6% to 43.1% (OR 0.71, 95% CI 0.53 to 0.95), following a drop between 1987 and 1997 (71.1% to 60.2%).
That's "despite progress by academic researchers in demonstrating the efficacy of several specific forms of psychotherapy for depression," the researchers wrote.
"It is not possible to determine whether declining use of psychotherapy reflects patient preferences for antidepressant medications or difficulties with access to psychotherapy related to a scarcity of local psychotherapists, financial or insurance coverage considerations, or other barriers," they said.
Those who did have psychotherapy had a decline in the mean number of visits and in the expenses for those visits.
A trend toward declining use of any psychotherapy was significant for patients ages 35 to 49, Hispanics, those with less than 12 years of education, Medicaid beneficiaries, and unemployed adults.
National expenditures for outpatient treatment of depression increased from $10.05 billion to $12.45 billion over the study period, although this was not a statistically significant increase.
However, there was a significant increase in Medicare expenditures for depression treatment, from $0.52 billion to $2.25 billion (P<0.001).
The researchers noted that despite the fact that more Americans are being treated for depression, it's "likely that a substantial number of patients with depression remain untreated."
They concluded that it will be important to "develop clinical policies that promote access to effective treatments for depression."
