Pocatello, ID—Patients refuse mental health treatment at a higher rate when it involves psychotropic drugs alone and are also more likely to discontinue the therapy even if they agree to it in the first place.

That’s according to a review of research published recently in the American Psychological Association’s journal Psychotherapy.

Idaho State University–led researchers conducted a meta-analysis of 186 studies of patients seeking help for mental health issues. The study team examined whether patients accepted recommended medication treatment and, if they did, whether they completed it. The issue of refusal of treatment recommendations was included in 57 of the studies, including 6,693 patients, and premature termination of treatment was addressed in 182 of the studies, comprising 17,891 patients.

After diagnosis, patients in the studies were recommended three alternatives:
• Drug-only therapy (pharmacotherapy) 
• Talk therapy (psychotherapy) or
• A combination of the two

“We found that rates of treatment refusal were about two 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, of Idaho State University. “Rates of premature termination of therapy were also higher for pharmacotherapy alone, compared with psychotherapy alone, particularly for anorexia/bulimia and depressive disorders.”

Overall, the average treatment-refusal rate was 8.2%, while patients who were offered pharmacotherapy alone were 1.76 times more likely to refuse treatment than patients who were offered psychotherapy alone. The average premature termination rate, meanwhile, was 21.9%, with patients on drug-only regimens 1.2 times more likely to drop out early. 

No significant differences for refusal or dropout rates were detected between pharmacotherapy alone and combination treatments, or between psychotherapy alone and combination treatments.

Swift said researchers were most surprised by how large the differences were for some disorders. He pointed out that patients diagnosed with depressive disorders were 2.16 times more likely to refuse pharmacotherapy alone and patients with panic disorders were almost three times more likely to refuse pharmacotherapy alone.

Although a greater percentage of mental health patients in the United States are engaging in pharmacotherapy than psychotherapy, that might not be the best approach, suggested co-author Roger Greenberg, PhD, of SUNY Upstate Medical University in Syracuse, NY. “Our findings support that argument, showing that clients are more likely to be willing to start and continue psychotherapy than pharmacotherapy,” Greenberg noted.

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