Psychotherapy played a larger role in outpatient psychiatric care, while psychotropic medications were used less often without psychotherapy. This is according to a new study from the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. The findings were published in the American Journal of Psychiatry.
“After American psychiatric care had been moving toward greater use of psychotropic medications for years, the pendulum is now swinging back toward psychotherapy,” said Mark Olfson, MD, MPH, professor of epidemiology and psychiatry at Columbia Mailman School.
Among adults who received outpatient psychiatric care between 2018 and 2021, the use of psychotherapy alone increased from 11.5 percent in 2018 to 15.4 percent in 2021; medication use decreased only from 68 percent to 62 percent. The number of psychotherapy visits and total national spending on psychotherapy ($31 billion to $51 billion) also increased, while the number of patients decreased.
The number of people receiving psychotherapy from psychiatrists decreased from 41 percent to 34 percent. Psychotropic medications included antidepressants—the most commonly used class of medication—antipsychotics, stimulants or other ADHD medications, anxiolytics or hypnotics, and mood stabilizers that were available at the pharmacy in the survey year.
Much of the change occurred between 2018 and 2019. This suggests that, in addition to the COVID pandemic and the increase in telemedicine, other factors contributed to the shift in outpatient psychiatric treatment, according to Olfson. During the study period, patients with mild or moderate distress saw a significant increase in the average number of visits, but not patients with severe disorders.
To examine recent national trends in outpatient psychiatric care, researchers analyzed data from four representative surveys of the U.S. household population, the Medical Expenditure Panel Survey 2018–2021, focusing on adults with outpatient psychiatric visits (17,821).
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