Medication or Talk Therapy?

If you only have money for antidepressants or to visit a psychiatrist, which should you choose? By Joanna Fantozzi Living with depression in New York is not only life-consuming, but can also be a drain on your wallet. The cost of a month's supply of Paxil, a common antidepressant, at the West 83rd Street Duane Reade is $190, and just one therapy session can cost hundreds of dollars. Doctors say a growing number of patients do not have mental health insurance coverage, yet are not poor enough to qualify for Medicaid. So spending hard-earned cash on both medication and therapy is difficult at best. "I would say about half of the patients at my private practice are uninsured," said Dr. Michelle Sheets, a clinical psychologist in Brooklyn. "If you're working as a waitress or something full-time but you're not below poverty line, you're really out of luck. It's unfair." But should a cash-strapped patient have to choose between medication or talk therapy? Doctors like Sheets say that it is impossible to generalize, and that the more effective solution is on a patient-by-patient basis. "Getting a good evaluation is key," said Dr. David Hellerstein, a professor of clinical psychiatry at Columbia University. "People are varied and their needs are different." For instance, patients experiencing more mild forms of depression, or first-time symptoms may be treated with visits to a psychiatrist, while patients with more severe symptoms or a history of mental health issues should also be treated with medication. Like any decision, choosing medication or therapy has its pros and cons. Sheets says she feels strongly about turning to cognitive behavioral therapy before medication. Although medication works quicker, she said cognitive behavioral therapy, which evaluates a patient's day-to-day lifestyle as opposed to a troubled childhood, really works. "Once you stop taking the meds, it doesn't last," said Sheets. "Cognitive behavioral therapy is about adding behavioral experience, like having your patient go out and do something that they love." But Dr. Norman Sussman, a psychopharmacology practitioner at New York University Langone Medical Center, believes that many patients do not have to go through the exorbitant costs and long periods of therapy. "People are worried about getting addicted to medication, but you can spend thousands of dollars in therapy and not feel any better," Sussman said. "For many people, medication alone can eliminate symptoms." Medication does not have to be expensive. At that same Duane Reade, the generic counterpart to Paxil costs only $55, and there is little evidence to suggest that name brands work better. Hellerstein also suggests getting medication from K-Mart or Target, where the price of medications can be even lower than a traditional drugstore's. For patients who want to go the therapy route, there are many ways to avoid a $600 therapist fee. Dr. Simon Rego, director of psychology training at Montefiore Medical Center in the Bronx, says therapists in training can see patients, and their fees are often more affordable. In the future, patients may not even have to pay for a therapist. Rego said that online applications for the evaluation and moderation of depression symptoms are starting to come out. Mobilyze, an app that detects mood fluctuations in depression patients, is currently in research trials at Northwestern University. "It's going to take a while to make a difference," said Rego, speaking about the costs of mental health care. "Part of the battle is educating the public to know the available treatments." At Columbia University Medical Center, Hellerstein said, free evaluative treatment is provided for people who participate in research studies. The Albert Ellis Institute on the Upper East Side has a similar participatory research program. The downside to this option, Hellerstein said, is that the medication choice is dictated by the research study. Even though there are multiple short-term options for patients who cannot afford depression treatment, doctors say that there is no one simple solution. Sheets believes that in the long run, the health care system itself has to change. "Mental health is supposed to be put on par with medical health care," Sheets said. "People miss work when they are depressed, so it even affects our economy. It's a bigger problem."