Patients More Likely to Seek Psychotherapy for Mental Health Disorders

Patients with depression were 2.16 times more likely to refuse pharmacotherapy.

A combination of prescription drugs and non-drug therapy is crucial for successful treatment of mental disorders for a majority of patients. New findings suggest that patients are more likely to refuse treatment drug therapy alone compared with psychotherapy, according to a study published by the journal Psychotherapy.

Included in the meta-analysis were patients seeking treatment for mental health disorders who took part in 186 other studies. Of these studies, 57 had a cohort of patients who refused treatment recommendations, and 182 studies had a cohort of patients who prematurely stopped treatment.

After patients were diagnosed, they were recommended to receive pharmacotherapy, psychotherapy, or a combination of both approaches.

"We found that rates of treatment refusal were about 2 times greater for pharmacotherapy alone compared with psychotherapy alone, particularly for the treatment of social anxiety disorder, depressive disorders and panic disorder," said lead researcher Joshua Swift, PhD. "Rates of premature termination of therapy were also higher for pharmacotherapy alone, compared with psychotherapy alone, particularly for anorexia/bulimia and depressive disorders."

The study authors found that the overall rate of treatment refusal was 8.2%. Interestingly, if only offered pharmacotherapy, patients were 1.76 times more likely to refuse treatment compared with psychotherapy recommendations, according to the study.

The average premature treatment termination rate was 21.9%, but pharmacotherapy patients were 1.2 times more likely to stop treatment early.

However, the authors said the differences in treatment refusal or cessation rates were similar between monotherapy and combination treatments.

While these findings were expected, the researchers observed significant differences between diagnoses and treatment refusals. Patients with depressive disorders were 2.16 times more likely to refuse pharmacotherapy, and patients with panic disorders were nearly 3 times more likely to refuse the treatment, according to the study.

The authors said these findings are of interest because as access to treatment increases, more patients are receiving pharmacotherapy than psychotherapy. Despite this trend, some mental health experts say that psychotherapy should be a first-line treatment option for patients with these disorders due to substantial evidence that links the treatment with low side effects and relapse rates.

“Our findings support that argument, showing that clients are more likely to be willing to start and continue psychotherapy than pharmacotherapy,” the study authors said.

These findings suggest that patients may be more likely to accept treatment with psychotherapy because many understand that their disorder has been caused by outside influences rather than biology, according to the study. The study did not identify underlying reasons behind their actions.

Further research to identify the differences in uptake and termination of pharmacotherapy and psychotherapy could lead to novel approaches to increase initiation and completion rates, according to the study.

"Patients often desire an opportunity to talk with and work through their problems with a caring individual who might be able to help them better face their emotional experiences," Dr Greenberg concluded. "Psychotropic medications may help a lot of people, and I think some do see them as a relatively easy and potentially quick fix, but I think others view their problems as more complex and worry that medications will only provide a temporary or surface level solution for the difficulties they are facing in their lives."