The antidepressant market is worth $20 billion in the U.S. Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005-2008 and the most frequently used by people age 18-44 (according to the National Center for Health Statistics). About one in 10 Americans age 12 and over takes an antidepressant medication.

But there is little evidence that pharmacotherapy should be used as a first line of treatment for mild to moderate depression.

Why are anti-depressants the first line of treatment for mild to moderate depression in the U.S.? The answer lies in the fact that the fastest-growth in prescribing anti-depressants is among primary care providers and specialists who are not psychiatrists – the front line providers of mental health care to patients in the U.S.

Females are 2.5 times more likely to take antidepressant medication as males. Twenty-three percent of women age 40-59 take antidepressants, more than in any other age-sex group. Among both males and females, those age 40 and over are more likely to take antidepressants than those in younger age groups.

As the chart shows, females are more also more likely than males to take antidepressant medication at every level of depression severity. More than one-third of females with moderate depressive symptoms, and less than one-fifth of males with moderate depressive symptoms take antidepressant medication.

About 14% of Americans taking antidepressant medication have done so for 10 years or longer. More than 60% of Americans taking antidepressants have done so for longer than 2 years.

Fewer than one-third of people taking a single antidepressant have seen a mental health professional in the past year. Among persons taking antidepressants, about 14% take more than one. Less than one-half of persons taking multiple antidepressants have seen a mental health professional in the past year. Among those taking multiple antidepressants, males are more likely than females to have seen a mental health professional in the past year.

Health Populi’s Hot Points: In the United Kingdom’s National Health Service, computerized CBT programs have become the first-line of depression therapy before prescribing anti-depressant medications. The NHS, constrained by budgets allocated to the UK’s Primary Care Trusts who provide first-line care for British health citizens, are well-advanced in telehealth compared with U.S. providers.

For mild to moderate depression, “psychotropic medication is under greater scrutiny. There are serious questions about efficacy,” Margie Morris of Intel told me. “We need new solutions,” Margie believes.

You can read about those “new solutions” Margie recommends in my paper, The Online Couch: Mental Health Care on the Web, published by California HealthCare Foundation earlier this month.  More about the NHS’s cost-effective approach to managing mild to moderate depression through CCBT can be found in the Evidence for tech-enabled behavioral health section of the report.