Dr. Olfson and Colleagues Reply

To the Editor: Our analysis of visits to office-based psychiatrists documented an overall decline in the duration of visits and an increase in the proportion of visits in which psychotropic medications are prescribed. Although we agree with Dr. Kahan that managed care offers a plausible explanation for much of the decrease in the duration of visits, we doubt that it fully explains the trend toward increasing prescriptions for psychotropic medications.

We have previously reported that a significant increase has occurred in the number of antidepressant prescriptions written for self-paying and privately insured patients (1). In our article, the decrease in the duration of visits disproportionately affected visits in which medications were not prescribed. For these reasons, we respectfully disagree with Dr. Kahan and continue to believe that new pharmacologic treatments and changing financial arrangements contributed to the reported changes in practice style.