The Importance of Cohesive Care

As I have previously discussed, it is likely that the combination of drugs and therapy is ideal. So where can a patient go to get both? Not many places. Psychiatrists and other medical doctors can prescribe medication. Psychologists and counselors are trained in talk therapy. Rarely do psychiatrists provide both services. This may seem like basic specialization, dividing tasks by education. At the very least, it's a new trend. A few decades ago, your psychiatrist would be your psychotherapist. What changed and why does it matter?

What happened?
1. Psychology developed in legitimacy and importance as an academic study over time and thus, more psychologists entered the market. They go through less school than psychiatrists, a fact that is especially important to the next point.

2. Prescribing drugs without performing psychotherapy became financially beneficial to psychiatrists. A psychiatrist is usually burdened with the debt of medical school. They often cannot afford to spend 45 minutes per client if they want to make good money and work reasonable hours. Also, certain insurance factors make it possible to charge more for a fifteen minute appointment to prescribe drugs that a longer appointment that includes therapy.

So what do we do now? Typically, if a family doctor or a psychiatrist prescribes a psychiatric drug, they will also refer the patient to some kind of psychotherapist. It is completely up to the patient whether they want to go and since the disconnect between the two professions, less people being treated for depression go through therapy. The first meeting with a psychiatrist includes a family history and gathering of information about the patient that lasts 45 minutes. The following meetings tend to be fifteen minute checkups in which the psychiatrist focuses on checking for any side effects to the drug and determining it's level of success. This alone can be very expensive. It seems that some patients have decided that to add a therapist on top of a psychiatrist is an unacceptable expense.

What does this have to do with the effectiveness of antidepressants? I have already discussed that antidepressants can be effective. I have discussed that they are usually better in conjunction with therapy, so the fact that less depressed patients are receiving therapy is not good. I have also mentioned that in rare cases the medications can have extremely serious side effects. Antidepressants, in many ways, are considered one of the less risky psychiatric drugs but this does not mean that the patients taking them do not need serious attention. Depression can not only be a destructive disease due to it's relation to a lack of motivation in life, but also because the side effects of the medication used to treat it can be serious. As it stands, according to an article written for The New York Times, psychiatrists not only spend little to no time in therapy with their patients, they also reach diagnoses ten times more quickly than they often would have in previous decades. Perhaps, part of this can be considered prompted an increase in psychiatric knowledge overall, but it is undeniable (and the psychiatrist interviewed even admits) that a psychiatrist is more likely to make a quick diagnosis because it is financially prudent to do so. This new method of psychiatry and psychology at the very least causes a disconnect between the person with insight into the mind of the patient and the person filling out the prescriptions. Is it not possible that ideal care would make the psychological insight a prerequisite for the prescription? Apparently some people think so! Not everyone has given up on the idea of combined psychiatry and psychotherapy. There still are options if you want one mental health professional in your life but at an astronomical cost. According to the New York Times, "top child psychiatrists charge $2000 or more for initial evaluations," including talk therapy.

This trend of separation, so motivated by the cold realities of economics, seems unstoppable. The kind of combined treatment that might both allow drugs more thorough monitoring in patients and ensure the constructive support of therapy is not in reach for the average citizen. However, mental health is a serious issue and depression is a common condition. It is not unreasonable to hope that society will begin to realize that it is in their best interest that therapy be brought back into the picture whether they have to pay extra or not. I believe the most effective way to take an antidepressant for major depression is as part of a cohesive and well-monitored treatment plan and part of that success relies on the expertise and attentiveness of both a psychiatrist and a psychologist.

"Psychiatrist, Psychologist, Counselor, Therapist: What's the Difference?" Lotus Group. Web. 12 Apr. 2012. <http://www.lotusgroup.biz/psychiatrist-psychologist-counselor-therapist-whats-the-difference

Harris, Gardiner. "Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy." The New York Times, 5 Mar. 2011. Web. 12 Apr. 2012. <http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?pagewanted=all>.

Grohol, John M. "Psychiatry Doesn't Do Psychotherapy Anymore." Psych Central.com. Web. 12 Apr. 2012. <http://psychcentral.com/blog/archives/2011/03/06/psychiatry-doesnt-do-psychotherapy-anymore/>.

Shapiro, Linda A. "DRUG THERAPY PAYS. TALK THERAPY COSTS and Is Often Being Tossed." Wellsphere. 20 Mar. 2011. Web. 12 Apr. 2012. <http://www.wellsphere.com/mental-health-article/drug-therapy-pays-talk-therapy-costs-and-is-often-being-tossed/1388263>.

"Psychiatry, Psychology, Counseling, and Therapy: What to Expect." WebMD. WebMD. Web. 12 Apr. 2012. <http://www.webmd.com/mental-health/guide-to-psychiatry-and-counseling>.