Consumer Reports Survey Rates Mental-Health Care Options for Depression and Anxiety

In one of the largest surveys of its kind, 3,079 Consumer Reports (CR) readers have rated the mental-health care they received for depression and anxiety. The survey results, plus CR’s interviews with patients and experts, offer a compelling snapshot of how people fared given the mental-health care choices they made.

Some key findings of “CR Investigates Antidepressants: Drugs vs. Talk Therapy,” published in the October issue, include:

* A combination of talk therapy and drugs often worked best for treatment of depression and anxiety. But “mostly talk” therapy was almost as effective if it lasted 13 or more visits.

* “Mostly drug” therapy was also effective for many people. Drugs had a quicker impact on symptoms than talk therapy, but it often took trial and error to find a drug that worked without unacceptable side effects. More than 50 percent of survey respondents who took antidepressants tried two or more drugs; 10 percent tried five or more.

* The rates of adverse drug side effects that our respondents experienced were much higher than those noted on the medications’ package inserts. Forty percent said they experienced a loss of sexual interest or performance, and almost 20 percent said they gained weight.

* Care from primary-care doctors was effective for people with mild problems, but less so for people with more severe ones. Treatment by mental health specialists yielded significantly better results for people who started out in poor shape.

* Health insurance plan limits on therapy visits and costs kept some people from getting the best treatment.

* Consumers who did their own research and monitored their own care reported better results.

* More than 80 percent of our survey respondents said they found treatment that helped.

The survey also highlights the fact that drug therapy has become a more prevalent mode of treatment for emotional problems in the last decade. When CR surveyed its readers in 1994, only 40 percent of those who sought care for any type of mental-heath problem received drugs compared with 68 percent in the current survey -- and 80 percent of those with depression or anxiety -- a number that reflects the fast-growing sales of antidepressant drugs over the past decade.

Survey respondents who took antidepressant medication, either with or without talk therapy, improved more quickly than those who had mostly talk therapy. But the improvement from drug treatment leveled off, regardless of the number of visits, whereas people who had more talk sessions did better than those who had only a few. While our results suggest that the options of talk therapy, drug therapy, or a combination can work for many cases of anxiety and depression, the combination of talk and drugs was the overall winner.

In 1994, survey respondents averaged well over 20 visits with a mental-health professional, while in the current survey the average was 10. Since our survey indicates that longer-term therapy is linked to more positive outcomes, this decline is troubling.

The experience of respondents yielded differences in both effectiveness and side-effect ratings for the six top-selling antidepressants: Effexor, Prozac, Celexa, Zoloft, Paxil, and Wellbutrin. The 1,664 survey respondents who took those antidepressants told CR whether the most recent one they took helped them “a lot” and whether they experienced common side effects. There was no clear favorite among the medications and the findings confirm those of clinical studies that there is no single antidepressant that will work for everyone. People who take antidepressants should be aware of the high risk of side effects. CR’s survey found the rate of sexual side effects for most drugs to be about three times the rate on package inserts. For many people, side effects were more than annoyances. Of the readers who said they stopped taking antidepressants, 34 percent said they’d done so because the side effects were intolerable.

Most people did get better in the number of visits for which their insurance coverage paid. But, of the 80 percent who secured treatment through their health plans, 23 percent said they had some type of problem with it, such as long waits for appointments or hassles with red tape. These frustrations, as well as privacy concerns, may lead some people to avoid using their health insurance to pay for their mental-health care.