Also fueling the trend, according to the report, was the aggressive marketing of psychotropic medications to psychiatrists and patients. That push, for example, has helped make antidepressants one of the largest-selling classes of drugs.
Dr. Mark Olfson of Columbia University Medical Center, a study author, said patient attitudes might also be hastening the shift. Taking a pill may look a lot easier to patients than psychotherapy, which is more time-consuming and may involve the regular participation of family members.
The report found evidence of a cultural preference for psychotherapy in the Northeast, which Olfson said might be attributable to the influence of the Yale School of Medicine and the University of Pennsylvania School of Medicine, whose faculties are strong proponents of psychotherapy.
Because the study looked only at psychiatrists, it couldn't determine whether patients who needed psychotherapy were receiving it from other mental health providers or going without treatment, Olfson said.
Dr. William H. Sledge, interim chairman of the department of psychiatry at Yale, said the report was worrisome. Although training in psychotherapy is a standard part of psychiatric training, he said, the know-how is in danger of becoming lost.
"A group of practitioners is losing an important skill. It is like going to war with fewer weapons at your disposal," Sledge said.
Dr. Alan F. Schatzberg, chairman of the department of psychiatry at Stanford University School of Medicine and president-elect of the American Psychiatric Assn., said the trend was not necessarily bad. It could be seen as a natural evolution, similar to what is seen in other fields of medicine.
"Years ago, if someone had a herniated disk, they had a very complicated surgical procedure and were in traction for weeks," he said. "Fields change. What we don't want to do is decide treatment based on reimbursement."
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denise.gellene@latimes.com
