Spending an hour in talk therapy with a trained counselor costs much more, and takes more time, than swallowing an inexpensive antidepressant pill.
But a new study shows for people with a new diagnosis of major depression, the costs and benefits of the two approaches end up being equal after five years.
The analysis was conducted using real-world data on treatment costs, positive and negative health effects, and impacts of treatment and depression symptoms on productivity.
It suggests that more people newly diagnosed with depression should have a chance to try individual and group sessions of cognitive-behavioral therapy, or CBT, as their first treatment, if they would prefer therapy over taking an antidepressant medication.
The research was conducted by a team from the University of Michigan and Harvard University.
National physician groups such as the American College of Physicians endorse giving people newly diagnosed with depression the option to choose either approach.
This would mean expanding the capacity of the healthcare system to provide greater access to psychotherapy than is currently available.
However, making CBT more available could save money for the companies and government agencies that pay for depression care – including by giving patients more depression-free time leading to improved performance at work.
In the study, the team built a detailed health economic model of depression treatment and added data from national clinical trials and sources of cost data.
Their results show that after one year, antidepressants do indeed cost much less, even when taking into account the physician visits needed to monitor treatment.
But after factoring in evidence about depression patients’ frequent need to try multiple medications before finding one that works for them, and their chance of going off their medications due to side effects and suffering a relapse, the balance of cost-effectiveness became more equivocal.
This new analysis adds to the evidence base about the cost-effectiveness of two commonly used depression treatments, and could thus guide treatment decisions, but more research is needed to get updated results about the long-term effects of the two options pitted head-to-head in a real-world setting.
The team also notes that the effects of health policy changes in recent years – requiring parity for mental health care for people covered by large private insurers, for instance, or allowing people in rural areas to receive CBT via video chat with a provider – should be measured too.
In the end, though, the shortage of trained mental health providers may do more to govern what kind of treatment patients receive.
Research indicates that the majority of people with depression would prefer to receive therapy instead of medications, but only one-quarter of them actually receive therapy.
The lead author of the study is Eric L. Ross, M.D., a psychiatrist at Harvard Medical School.
The study is published in Annals of Internal Medicine.
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