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Original Article
December 6, 2010

National Trends in the Treatment for Depression From 1998 to 2007

Author Affiliations

Author Affiliations: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Dr Marcus); School of Social Policy & Practice, University of Pennsylvania, Philadelphia (Dr Marcus); and Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York (Dr Olfson).

Arch Gen Psychiatry. 2010;67(12):1265-1273. doi:10.1001/archgenpsychiatry.2010.151

Context  The rate of outpatient treatment of depression increased markedly in the United States between 1987 and 1997; it is not known whether this trend has continued.

Objective  To assess national trends in the outpatient treatment of depression between 1998 and 2007.

Design and Setting  Analysis of service utilization data from 2 nationally representative surveys of the US household population, the 1998 (n = 22 953) and 2007 (n = 29 370) Medical Expenditure Panel Surveys.

Participants  Nationally representative sample of the US household population.

Main Outcome Measures  The rate of depression treatment and, among patients who received treatment, the rate of antidepressant medication use, psychotherapy, number of outpatient treatment visits, and expenditures.

Results  The rate of outpatient treatment for depression increased from 2.37 per 100 persons in 1998 to 2.88 per 100 persons in 2007 (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.03-1.35). The percentage of treated patients who used antidepressants was little changed from 73.8% (1998) to 75.3% (2007) (AOR, 1.14; 95% CI, 0.85-1.51), but the percentage of those receiving psychotherapy declined from 53.6% (1998) to 43.1% (2007) (AOR, 0.71; 95% CI, 0.53-0.95). National expenditures for the outpatient treatment of depression increased from $10.05 billion to $12.45 billion (z = 1.73, P = .08). This was primarily driven by an increase in medication expenditures from $4.59 billion (1998) to $6.60 billion (2007) ( = 2.88, P = .004), which in turn was related to an increase in Medicare expenditures for depression treatment from $0.52 billion (1998) to $2.25 billion (2007) (z = 5.62, P < .001).

Conclusions  Rapid increases in depression treatment from 1987 to 1997 were followed by more modest increases during the following decade. Although there was little change in the proportion of patients receiving antidepressants, treatment with psychotherapy has declined.