Running from Depression

Scott Douglas, writing in Slate, on why doctors don’t prescribe the very effective treatment of moving for depression:

Why is the United States such an outlier? Structural barriers may be to blame. The U.S. health care system famously incentivizes procedures and pills over a holistic approach. That might be especially true with antidepressants, which the National Institute of Mental Health concedes are increasingly prescribed for “off-label” uses, meaning conditions like insomnia, pain, eating disorders, and migraines, rather than depression. This tendency to prescribe, and specifically to prescribe antidepressants, contributes to the aura of “they might help, and they probably won’t hurt,” despite warranted debate over their effectiveness for depression. A system that encourages such practices is at odds with a prescription of “get outside and move for half an hour most days” for depression.

Of course, the real answer is that doctors do tell patients to exercise.

What is this famous “incentivization” for pills over a holistic approach? A psychiatrist does not get paid for prescribing a medication. There are no kickbacks in the 21st century. Complexity in note-writing is a documentation burden, and certainly needing to evaluate labs etc might result in higher billing per visit, but the “incentivization” as such could better be framed: there isn’t much time in a 15-minute med check slot to do anything other than offer an Rx.

As the husband of a psychiatrist, the real story here is patient expectation: a lot of people don’t want to get a lecture on sleep hygiene; they want a sleeping pill.

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