Medicine
Family physicians commonly treat patients with depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), sleep disorders, and other psychiatric conditions. Although some patients respond to medication, prescribing has significant downsides. Antidepressants can increase suicide risk, and a study that once declared medications to be superior to behavioral therapy for ADHD is now receiving a second look. In contrast, an article by Drs. Scott Coffey, Anne Banducci, and Christine Vinci in the November 1st issue of American Family Physician reported that cognitive behavior therapy (CBT) effectively relieves symptoms of all of these conditions, plus those from post-traumatic stress disorder, autism, obsessive-compulsive and tic disorders, personality disorders, and eating disorders. The article answered several common questions about CBT, including how it works:
The aim of CBT is to help patients adopt more adaptive patterns of thinking and behavior to improve function and quality of life. Treatment goals are selected collaboratively with patients to determine whether progress is being made. CBT involves three core strategies applied alone or in combination, depending on the patients' needs: (1) identifying and challenging problematic thoughts and beliefs, with the goal of helping patients develop more realistic and adaptive thoughts and beliefs, (2) scheduling pleasant activities to increase environmental reinforcement, and (3) extended exposure to unpleasant thoughts, situations, or physiologic sensations to decrease avoidance and arousal associated with anxiety-eliciting stimuli.
- Drug Prices And Corporate Greed: There May Be Limits To Our Gullibility
“A Huge Overnight Increase in a Drug’s Price Raises Protests”, by Andrew Pollack in the New York Times September 20, 2015, features the story of Daraprim, the brand name for pyrimethamine, a drug used to treat toxoplasmosis. “Toxo”, often associated...
- “conservative” Drug Prescribing
While Victor Fuchs in his (somewhat pessimistic) commentary on “Reforming US health care” in a recent JAMA observes that one problem with the Clinton-plan era was that the public focused on “…`greedy drug companies’ and ‘overpaid’ physicians...
- Will New Adult Depression Guidelines Have An Impact?
Major depressive disorder is a common condition that responds to psychotherapy and medications, and several screening tools have been validated for use in primary care. However, screening tools will not work if doctors are unable or unwilling to use them;...
- "too Much Medicine" Potpourri
Last week was a busy one: I presented at the American Academy of Family Physicians Assembly (on lung cancer) and the Family Medicine Education Consortium Northeast Region Meeting (on prevention politics); participated in a Lown Institute-sponsored meeting...
- Effective Health Care For Children With Autism Spectrum Disorders
A recent report from the Centers for Disease Control and Prevention found that the prevalence of autism spectrum disorders (ASDs), estimated at 1 in 110 children in a 2010 American Family Physician article, may now have risen as high as 1 in 88. Previous...
Medicine
Compared to some pills, cognitive behavior therapy is a bargain
Family physicians commonly treat patients with depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), sleep disorders, and other psychiatric conditions. Although some patients respond to medication, prescribing has significant downsides. Antidepressants can increase suicide risk, and a study that once declared medications to be superior to behavioral therapy for ADHD is now receiving a second look. In contrast, an article by Drs. Scott Coffey, Anne Banducci, and Christine Vinci in the November 1st issue of American Family Physician reported that cognitive behavior therapy (CBT) effectively relieves symptoms of all of these conditions, plus those from post-traumatic stress disorder, autism, obsessive-compulsive and tic disorders, personality disorders, and eating disorders. The article answered several common questions about CBT, including how it works:
The aim of CBT is to help patients adopt more adaptive patterns of thinking and behavior to improve function and quality of life. Treatment goals are selected collaboratively with patients to determine whether progress is being made. CBT involves three core strategies applied alone or in combination, depending on the patients' needs: (1) identifying and challenging problematic thoughts and beliefs, with the goal of helping patients develop more realistic and adaptive thoughts and beliefs, (2) scheduling pleasant activities to increase environmental reinforcement, and (3) extended exposure to unpleasant thoughts, situations, or physiologic sensations to decrease avoidance and arousal associated with anxiety-eliciting stimuli.
Finding a qualified therapist many be a challenge in some communities, and CBT usually doesn't come cheaply. However, CBT for most conditions is time-limited: one session per week for 8 to 12 weeks. At $150 to 200 per session, the typical cost for a treatment course would be between $1200 and $2400.
In comparison, a one-month supply of the newer antidepressants levomilnacipran, vortioxetine, and vilazodone (which are labeled only for treatment of major depressive disorder in adults, and are often prescribed indefinitely) cost $286, $254, and $149, respectively. So a newer antidepressant could cost as much or more than a course of CBT in as little as 4 to 8 months.
But in the weird economics of health care, CBT is a relative bargain only because it actually involves skilled professionals talking to patients, something that our medical system consistently undervalues. If CBT could somehow be packaged into a pill and patented instead, it would likely cost a lot more, given its versatility and enormous potential market share. It might become the next big blockbuster drug, like newer antiviral treatments for hepatitis C that cost between $84,000 and $156,000 for a 12-week course of treatment, or $1000 or more for a single pill. Or, since CBT has been around since the 1960s, perhaps a better benchmark would be the infamous recent example of the 62 year-old drug pyrimethamine (Daraprim), whose manufacturer raised the per-tablet price from $13.50 to $750, literally overnight.
**
A slightly different version of this post first appeared on the AFP Community Blog.
**
A slightly different version of this post first appeared on the AFP Community Blog.
- Drug Prices And Corporate Greed: There May Be Limits To Our Gullibility
“A Huge Overnight Increase in a Drug’s Price Raises Protests”, by Andrew Pollack in the New York Times September 20, 2015, features the story of Daraprim, the brand name for pyrimethamine, a drug used to treat toxoplasmosis. “Toxo”, often associated...
- “conservative” Drug Prescribing
While Victor Fuchs in his (somewhat pessimistic) commentary on “Reforming US health care” in a recent JAMA observes that one problem with the Clinton-plan era was that the public focused on “…`greedy drug companies’ and ‘overpaid’ physicians...
- Will New Adult Depression Guidelines Have An Impact?
Major depressive disorder is a common condition that responds to psychotherapy and medications, and several screening tools have been validated for use in primary care. However, screening tools will not work if doctors are unable or unwilling to use them;...
- "too Much Medicine" Potpourri
Last week was a busy one: I presented at the American Academy of Family Physicians Assembly (on lung cancer) and the Family Medicine Education Consortium Northeast Region Meeting (on prevention politics); participated in a Lown Institute-sponsored meeting...
- Effective Health Care For Children With Autism Spectrum Disorders
A recent report from the Centers for Disease Control and Prevention found that the prevalence of autism spectrum disorders (ASDs), estimated at 1 in 110 children in a 2010 American Family Physician article, may now have risen as high as 1 in 88. Previous...