The Drawbacks of Pharmacotherapy Without Accompanying Psychotherapy

My thanks to Stahmeyer et al. for their analysis of the state of care for persons with depression (1). On the basis of these data, further interesting aspects can be deducted in addition to the conclusions reached by the authors. In the S3 guideline for the treatment of depression, psychotherapy without pharmacotherapy can be considered in moderately severe depressive episodes. It is therefore surprising that 60% were given pharmacotherapy, but only 10% psychotherapy. This clearly marks underprovision of psychotherapy without explaining it in greater detail. Data show that pharmacotherapy without accompanying psychotherapy for recurrent depression has disadvantages/drawbacks for further episodes in the long term (2). As the waiting time for a psychotherapy place is currently about 20 weeks, these numbers are, however, unsurprising (3). Optimal needs based planning is required, as is an upgrade of talking therapy medicine. The fact that most patients are (thankfully) treated by general practitioners is also identifiable as a healthcare deficit. Pharmacotherapy requires fundamental specialist medical knowledge, especially in a scenario of non-response and because of interactions and adverse effects. Finally, let me say, as a geriatric psychiatrist, that on the basis of these data the numbers of older people with depression barely differs from those of younger people. But the healthcare deficit is even more pronounced in older people—patients older than 65 receive substantially less psychotherapy (4). In view of a steadily ageing population, this healthcare bottleneck is going to narrow even more. What would be desirable is to train psychotherapists more intensively in this area, so as to abolish stigmatizing comments such as “older people are less motivated to change” and thus reduce the access threshold for psychotherapy places.